Melasma: why it keeps coming back and how to keep it away

Melasma is a common skin condition that causes brown or grey-brown patches, usually on the cheeks, forehead, upper lip, nose and chin. It is much more common in women, and it tends to return: it can fade with treatment, then come back with sun, hormones or irritation.

Quick answer: Protect your skin from sunlight every day with a broad-spectrum tinted sunscreen containing iron oxides, plus a hat and shade. Add one or two proven fading ingredients, such as azelaic acid, a retinoid or tranexamic acid, or ask a dermatologist about prescription creams. Results usually take months, and most people need ongoing maintenance to keep patches away.

What melasma looks like and who gets it

Melasma patches are flat, not raised, and often appear evenly on both sides of the face. They can also show up on the forearms and neck. It is a type of hyperpigmentation, which means extra pigment in the skin. It is harmless, but it can affect how people feel about their skin.

DermNet notes that melasma is more common in women than in men, usually starts between ages 20 and 40, and is most common in people with light brown to medium brown skin. Men can get it too.

Melasma is different from sun spots, freckles and the dark marks left after acne. If you are not sure which you have, compare the Glowpedia guides to melasma and dark spots, and ask a dermatologist to confirm.

What triggers melasma and why it comes back

The exact cause is not fully understood, but several factors play a part:

• Sunlight. Ultraviolet (UV) rays and visible light both encourage pigment cells to make more melanin, the pigment that colors skin. This is why melasma often darkens in summer.
• Hormones. Pregnancy (melasma is sometimes called the "mask of pregnancy"), birth control pills and hormone therapy.
• Stress, which the American Academy of Dermatology (AAD) lists as a possible trigger.
• Genes. It often runs in families.
• Irritation. Harsh products, scrubs and some procedures can inflame the skin and darken patches.
• Heat. Some people notice melasma worsens with heat, such as cooking over a hot stove or saunas, though this is less well studied.

Melasma comes back because the pigment cells in affected skin stay easily "switched on". Treatment fades the extra pigment but does not change that tendency, so protection needs to continue even after the patches fade.

Daily sun protection: the most important step

Fading creams work poorly without daily protection, and a few unprotected days in strong sun can undo months of progress.

1. Use a broad-spectrum sunscreen every morning, SPF 30 or higher. DermNet suggests a very high protection sunscreen (SPF 50+) that contains iron oxides.
2. Choose a tinted formula. The tint comes from iron oxides, color pigments that also help block visible light, which untinted sunscreens filter less well. Tints also avoid a white cast.
3. Reapply every two hours outdoors, and after swimming or sweating.
4. Add a wide-brimmed hat, sunglasses and shade, especially in the middle of the day. Apply sunscreen on cloudy days and near bright windows too.

Read more on sun protection and mineral sunscreen filters.

Creams and serums that can fade melasma

Fading treatments slow pigment production or help pigmented cells shed. Most people do best with one or two, used steadily, rather than many at once.

Learn more about azelaic acid, tranexamic acid, brighteners and retinoids. Retinoids can make skin more sensitive, so use sunscreen every day. If you are pregnant or breastfeeding, ask your doctor before using it.

A word on hydroquinone

The US Food and Drug Administration (FDA) says there are no legally marketed over-the-counter skin lightening products in the US; hydroquinone is available there only by prescription. The FDA has received reports of rashes, facial swelling and ochronosis, a bluish-black darkening of the skin that may be permanent, linked to unregulated lightening products. Some products sold online have also been found to contain mercury. Use hydroquinone only under a doctor's care, and avoid unlabeled "whitening" creams.

Tranexamic acid tablets

Tranexamic acid taken by mouth is a prescription medicine. The AAD notes it has been shown to reduce melasma patches when other treatments have not worked. Because it affects blood clotting, a doctor needs to review your health first, especially any history of blood clots. Talk to your doctor, and never buy it online.

Procedures: peels, lasers and microneedling

Dermatologists may offer chemical peels, microneedling, lasers or light treatments when creams are not enough. DermNet warns that peels and lasers can make melasma worse or leave new dark marks after inflammation, and that melasma often returns after laser treatment. The risk is higher in medium and deep skin tones.

If you are considering a procedure:

• Choose a board-certified dermatologist with melasma experience.
• Expect to use fading creams before and after.
• Ask about the risk of darkening for your skin tone.

Results and safety depend on a qualified professional.

What not to mix or do

• Lemon juice, harsh scrubs and strong home peels: irritation can darken melasma.
• Unlabeled whitening creams: they may contain mercury, steroids or hydroquinone at unknown strengths.
• Hydroquinone for long periods without a doctor.
• Retinoids or hydroquinone during pregnancy unless your doctor approves.
• Several strong actives at once: see brighteners + vitamin C or niacinamide for gentle ways to combine them.

How long until you see results

The AAD says it usually takes 3 to 12 months to see results, and longer if melasma has been there a long time. Patches often lighten slowly and then level off. Melasma can return with summer sun, so keep up sunscreen all year.

Melasma and pregnancy

Melasma often appears during pregnancy. The AAD notes that it can fade after you deliver your baby, or after you stop the medicine that triggered it. During pregnancy, focus on sunscreen, hats and shade. Many fading treatments are not advised, so ask your doctor which ones are safe for you.

When to see a dermatologist

See a dermatologist:

• To confirm it is melasma, since other conditions can look similar.
• Before using prescription creams or tranexamic acid tablets.
• If patches don't improve after a few months of daily sunscreen and a fading product.
• If a product makes your skin darker, red or sore.
• Right away for any spot that is raised, growing, changing color, bleeding or itching.

FAQ

Will melasma go away after pregnancy?

It can fade after delivery, but not always. Daily sun protection gives it the best chance, and a dermatologist can suggest treatments once you are no longer pregnant or breastfeeding.

Can men get melasma?

Yes, though less often than women. The same sun protection and treatments apply.

Is my phone causing melasma?

Screens give off far less light than the sun, so daylight is the bigger concern. Daily tinted sunscreen covers both.

Can melasma be removed for good?

There is no permanent fix yet. Most people can fade it and keep it lighter with daily protection and maintenance treatment.

Sources

• Melasma: Diagnosis and treatment (American Academy of Dermatology)
• Melasma (DermNet)
• Skin facts! What you need to know about skin lightening products (US FDA)
• FDA warns consumers of skin products containing mercury and/or hydroquinone (US FDA)