I got melasma suddenly, along with fatigue, weight gain, fibromyalgia...I discovered my progesterone was high, and took a herb for that..which stopped the melasma from spreading. Then I went into all the creams, acids etc for my face, with no permanent change, and damaged my skin a bit. I also went to a good endocrinologist for my thyroid. So one day I start a ketogenic diet, because I am peri menopausal, and nothing is budging the weight. I read this is a good diet for menopausal women with water retention, sleep issues etc. And the melasma is fading. I don't put anything on my face now. Eating lots of coconut oil, butter, eggs...my hair is better..not falling out like it was before. I'm still getting my periods, no longer taking any supplements for high progesterone.Just putting it out there...maybe our diets are messed up and messing wth our hormones. I always believed melasma had an internal cause, but I didn't think it would be solved by changing my diet in a major way. I thought I needed tons of supplements for hormonal imbalances. My cupboard looks like a drug store after all these years!!before the melasma, I was eating high protein. High exercise. Now I have to eat high (good) fats, moderate exercise. But it is clearing the melasma. And I'm slowly losing the weight I gained. The keto diet is probably doing good things hormonally and otherwise that the supplements couldn't do. I'm guessing.