Melasma

As a particularly difficult-to-treat condition, melasma presents as dark patches on the skin. Learn more about its causes and the treatment options available for those experiencing this kind of unwanted discoloration.

As a particularly difficult-to-treat condition, melasma presents as dark patches on the skin. Learn more about its causes and the treatment options available for those experiencing this kind of unwanted discoloration.

Medically reviewed by Nissan Pilest, MDDermatologic Surgeon, Board Certified in Dermatology
Written byKali SwensonUpdated on July 6, 2021
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.
Melasma 754x484
Melasma 754x484

A form of hyperpigmentation (excess pigment in the skin), melasma shows up as flat, irregularly shaped gray or brown patches, commonly on the forehead, cheeks, nose, and upper lip. It can also appear on the neck and forearms and can span the whole area where it appears, such as the “melasma mustache” across the length of the upper lip.

Also known as chloasma, melasma can be epidermal (on the skin’s surface, in the epidermis), dermal (under the surface of the skin, in the dermis), or both. Hyperpigmentation that’s deeper in the skin is more difficult to treat.

While people with medium to dark skin (Fitzpatrick skin types IV–VI) are more likely to develop melasma because their skin has more active melanin-producing cells, called melanocytes, fairer complexions are not immune.

Unlike postinflammatory hyperpigmentation, which is caused by injury or irritation (like acne, eczema, or bug bites), melasma is typically triggered by two main risk factors: hormonal changes and UV radiation from sunlight.

  • Hormone changes. According to the American Academy of Dermatology, 90% of people who get melasma are women. Often dubbed “the mask of pregnancy,” the skin condition is especially common in pregnant women, whose estrogen and progesterone levels overstimulate melanin production. Birth control pills and hormone replacement therapies can trigger it as well. However, most melasma treatments are not safe for women who are pregnant or breastfeeding.
  • Sun exposure. Sun can both bring on melasma and worsen existing patches, since UV light speeds up melanin production. “Sun exposure will immediately ramp up the pigment production, if you aren't protected with a full-spectrum sunscreen,” says Dr. Nissan Pilest, a dermatologic surgeon in Irvine, California.

Other factors, like heat, visible light, thyroid disease, and stress, can contribute to or exacerbate melasma. 

Treatments to improve the appearance of melasma focus on releasing the excess pigment from the skin and encouraging cell turnover. Removing old layers of the skin makes room for fresh, healthy cells and brings trapped pigment to the surface so it can be shed.

If you have olive or brown skin, it’s essential to find a dermatologist who’s experienced in treating dark skin tones. Unfortunately, all the most effective melasma treatments carry risks of triggering more hyperpigmentation or hypopigmentation (spots that lose pigment and appear lighter than the rest of the skin), so it’s important to ease in, with an abundance of caution, to prevent potential remedies from backfiring and worsening your condition.

There is no cure for melasma, so the condition never fully resolves. Even patches that seem to fade completely almost always come back. Improving melasma requires ongoing professional and topical treatments, in combination with diligent sunscreen use and sun avoidance. Results from even the best treatments won't hold if patients don’t apply (and reapply) sunscreen with an SPF of 30+ every day.

These are the melasma treatment options that doctors and RealSelf members say work best.

Cosmelan (Page Image)Cosmelan

nonsurgical

Retin-A (Page Image)Retin-A

nonsurgical

Chemical Peel (Page Image)Chemical Peel

nonsurgical

IPL (Page Image)IPL

nonsurgical

Worth It Rating67%100%92%79%87%
Average Cost$750$75$425$650$2125
Downtime1 week of downtimeNo downtimeUp to 2 weeks of downtimeOne week of social downtime1–12 days of downtime (depending on intensity)
Anesthesia No anesthesiaNo anesthesiaTopical anesthesia
  • Cosmelan is a system that combines an in-office chemical peel and an at-home cream. Both the peel (Cosmelan 1) and cream (Cosmelan 2) contain ingredients that suppress melanin production. Active ingredients in Cosmelan 1 include azelaic acid, kojic acid, phytic acid, ascorbic acid, arbutin, and titanium dioxide. Cosmelan 2’s active ingredients are titanium dioxide, kojic acid, phytic acid, and ascorbic acid.  “The Cosmelan peel penetrates deep into the skin, to decrease the natural production of the tyrosinase enzyme,” says Dr. Sacha Obaid, a plastic surgeon in Southlake, Texas. Tyrosinase is the enzyme that catalyzes the production of melanin, so inhibiting the activation of tyrosinase reduces the amount of melanin synthesized and carried to the superficial layers of the skin. Find doctors who offer Cosmelan
  • Retin-A, aka tretinoin, has been clinically shown to increase cell turnover and stimulate collagen growth, encouraging fresh new skin with a more even tone and smoother texture. This topical, prescription-only retinoid (a vitamin A derivative) is available in cream or gel form at percentages ranging from 0.01% to 0.25%. It can be applied daily (or, at least, a few times a week, if you’re prone to skin irritation) as part of your nighttime skin-care routine.  Find doctors who offer Retin-A
  • Chemical peels, like glycolic acid peels and TCA peels, use exfoliating acids to “unglue” the surface layers of old, dead skin cells, encouraging cell turnover and revealing healthy new skin. Chemical peels can be mild, medium, or deep, depending on how thoroughly they penetrate the skin. The deeper the peel, the longer the downtime. Deep peels also carry more risk of causing hyperpigmentation in olive and brown skin, so discuss the possible side effects with your doctor before undergoing a peel.  Find doctors who offer chemical peels
  • Intense pulsed light (IPL) specifically targets brown pigment in the skin. The treatment delivers an arc of broad-spectrum light that penetrates all layers of the skin, so it can treat both surface and dermal melasma. After an IPL treatment, the pigmented areas will darken before the pigment appears to rise to the surface and then fade or flake away within a couple weeks. Studies have found IPL to deliver visible results in melasma patients; however, it’s important to note that IPL is not safe for and should not be used on dark skin tones, since melanin absorbs the light energy, making skin more likely to burn and potentially scar.  Find doctors who offer IPL
  • Laser resurfacing, such as Fraxel and the CO2 laser, are proven methods for improving the appearance of melasma and other forms of hyperpigmentation. Each works a little differently, but the lasers generally use an intense beam of light to spur cell regeneration and reveal brighter, more even skin. Laser treatments may be ablative or non-ablative. Ablative lasers remove superficial layers of skin, while non-ablative lasers leave the surface of your skin intact while targeting the lower layers. The levels of pain, downtime, and risk are higher for ablative laser treatments, so most doctors now favor non-ablative or fractional lasers (which remove only a fraction of the surface layer and leave the rest intact). Find doctors who offer laser resurfacing

Because melasma flares up when skin is exposed to the sun, being diligent about sun protection is key to managing it. Make wearing sunscreen, including frequent reapplication, a daily habit. 

Physical sunscreens, rather than chemical formulas, are more effective for melasma because they stop more visible light and both UVA and UVB radiation from reaching the skin. Zinc oxide and titanium dioxide reflect light away from your skin, whereas chemical sunscreens work by absorbing the light. Senté Invisible Shield Full Physical Broad Spectrum SPF 49 Sunscreen ($38) is a favorite among doctors on RealSelf.

For at-home treatment of melasma, hydroquinone lotions are a popular and very effective option. The depigmenting agent reduces the number of melanocytes in the skin and effectively bleaches the areas where it’s applied. You can buy hydroquinone creams at up to 2% concentration over the counter or get a stronger prescription from a dermatologist. A good option is the Obagi Nu-Derm Skincare System, which is a seven-piece set containing hydroquinone as the main ingredient. Since two of the products within this set feature 4% hydroquinone, a prescription is required. 

Hydroquinone is classified as a potentially dangerous skin allergen and has been banned in the European Union, Japan, and Australia, but the FDA considers it safe. Consult with your doctor, to decide if it’s right for you. They may recommend other topical products that contain alternative lightening agents, like kojic acid, arbutin, or tranexamic acid.

Related: The Controversy Over Hydroquinone, Explained

Updated July 6, 2021

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