What Is Melasma? Causes, Triggers & Treatment Options

If you’ve noticed dark patches appearing on your cheeks, forehead, upper lip, or other areas of your face, you may be dealing with melasma. While melasma is harmless, many people find the uneven pigmentation frustrating and are eager to understand why it develops and seek treatment. According to Dr. Edgar Martinez of U.S. Dermatology Partners Plano, “Melasma can be challenging because it often has multiple contributing factors, including sun exposure, heat, hormones, and genetics. The good news is that there are effective ways to manage melasma and improve skin tone with the right treatment plan.” In this blog, Dr. Martinez explains what melasma is, its most common causes and triggers, and the treatment options available to help reduce discoloration and prevent future flare-ups.

What Is Melasma?

So, exactly what is melasma? According to Dr. Martinez, “Melasma is a skin condition that causes darkening of skin due to overproduction of melanin, from the pigment-producing melanocyte skin cells. For those with melasma, overproduction of melanin leads to patches of darker skin.” Melasma most often develops on the face, especially on the cheeks, forehead, upper lip, and jawline. Melasma often develops symmetrically, so if a melasma patch develops on the left cheek, it may also develop on the right. While both men and women can develop melasma, it is more common in women. Melasma is a chronic skin condition, which means long-term treatment and maintenance are often necessary to keep discoloration under control.

What Does Melasma Look Like?

The most common characteristic of melasma is hyperpigmentation on the face. These patches can be tan or brown in color, depending on natural skin tone. In most melasma patients, patches darken over time, especially after sun exposure. Melasma patches can be large and may blend together. Others are small and scattered. Melasma tends to develop in common patterns, including clusters in the center of the forehead, larger patches across the cheeks, and spots on the bridge of the nose.

Not all hyperpigmentation is melasma. Understanding the differences between melasma and other common causes of skin discoloration can help patients seek the most appropriate treatment.

• Melasma vs. sunspots – sunspots, also known as solar lentigines, are caused by the cumulative effects of UV damage. Sunspots are usually small, defined, round, and oval-shaped. They tend to appear individually rather than in the symmetrical patterns often seen with melasma. Sunspots commonly develop on the face, hands, chest, and shoulders.
• Melasma vs. freckles – freckles tend to be small spots that are concentrated in specific areas. They usually develop in childhood, and they may last into adulthood or fade with time. When exposed to UV rays, freckles tend to darken like melasma patches.
• Melasma vs. post-inflammatory hyperpigmentation (PIH) – PIH develops after inflammation or skin injury, such as acne, eczema, or an injury. Unlike melasma, which is often linked to hormones, genetics, and sun exposure, PIH occurs directly at the site of the inflammation or injury and appears as darkened patches or spots.

Common Melasma Triggers

There’s no one trigger for melasma flareups but understanding melasma causes is an essential aspect of the treatment process. Some of the common causes of melasma include:

• Hormonal changes – fluctuation in hormonal production is one of the leading causes of melasma. Taking oral contraceptives or hormone replacement therapy, pregnancy, and menopause can all trigger melasma flareups. Melasma is so common in pregnancy that it is often referred to as the mask of pregnancy.
• Sun exposure – even small amounts of UV radiation can worsen melasma patches or trigger flareups in this condition. When skin tans or burns, it can develop because of the overproduction of melanocytes. This can make melasma patches darker or more difficult to clear up.
• Visible light – sunlight is just the beginning. Screens and indoor lighting can also worsen pigmentation. This is especially true for those with darker skin tones.
• Heat – high temperatures, saunas, steam rooms, and even cooking over high heat can trigger melanocyte activity. Consistent protection and avoidance of high temperatures can help reduce the risk of melasma flareups.
• Genetics – a family history of melasma and other pigmentation issues may increase the likelihood of developing this condition.
• Skin tone – while melasma can occur in patients of all skin tones, it is most common in those with darker tone because they have naturally more active melanocyte cells. This leads to an increased susceptibility of pigmentation disorders.
• Medications – there are some medications that increase pigmentation risk by making skin more sensitive to sunlight, including certain antibiotics, anti-seizure medication, and hormonal treatment.

Why Is Melasma So Difficult to Treat?

According to Dr. Martinez, “One of the reasons melasma can be challenging to treat is that there is rarely a single cause. It’s not just excessive pigment. Instead, melasma develops via multiple pathways, including overactive melanocytes, blood vessel damage or changes, inflammation, hormonal shifts, and sun damage. In addition, pigment can deposit in different layers of the skin, making it harder for some creams to help. This chronic, inflammatory skin condition requires patience and consistency.” When it comes to understanding dermatologist treatment for melasma, Dr. Martinez explains patients need to keep a few things in mind:

• There is no simple cure – treating melasma takes time, patience, and consistency. The right treatment leads to slow, steady improvement.
• Aggressive treatments aren’t always better – even though it may seem like a stronger or more advanced treatment will lead to faster improvement, these harsher and more invasive treatments can actually cause unnecessary irritation and inflammation that worsens flareups.
• Management is long-term – even after melasma improves, recurrence is common. Ongoing sun protection and maintenance treatments are often needed to help prevent future flare-ups.
• Personalized care is essential – no melasma treatment works the same for every patient. Instead, dermatologists will evaluate skin tone, hyperpigmentation severity, skin sensitivity, hormonal fluctuations, and lifestyle habits. By considering the full picture, dermatologists are able to recommend a personalized plan to manage melasma.

Dermatologist-Recommended Melasma Treatments

Because melasma is a chronic condition with multiple contributing factors, successful melasma treatment requires a comprehensive approach. While in-office procedures may be recommended, daily sun protection and consistent at-home skincare play a critical role in managing discoloration and preventing flare-ups. Some often recommended melasma treatments include:

• Hydroquinone – this product works by reducing melanin production. It reduces pigmentation gradually. However, excessive use of hydroquinone can lead to adverse side effects.
• Retinoids – these help increase skin cell turnover to gradually reduce hyperpigmentation and improve the absorption of skin brightening agents. Retinoids improve general skin tone and texture and encourage collagen production.
• Azelaic acid – this gentle skincare ingredient is beneficial to reduce hyperpigmentation and inflammation. It brightens and boosts skin health. It’s an ideal option for those with acne-prone skin and melasma. Azelaic acid is also helpful for those with sensitive skin because it has a lower risk for irritation.
• Vitamin C – this antioxidant helps protect the skin from free radical damage caused by UV exposure and other environmental stressors. When used as part of a comprehensive skincare routine that includes daily sunscreen, vitamin C may help brighten the complexion and improve the appearance of hyperpigmentation.
• Tranexamic acid – this ingredient can regulate the body’s responses that lead to pigmentation and inflammation. It’s so beneficial, tranexamic acid may be used topically, taken orally, or applied as part of dermatologic procedures.
• Kojic acid – this ingredient is derived from fungi. It inhibits melanin production and brightens skin tone. Kojic acid and other skin lightening agents may be combined to achieve more dramatic results.
• Combination treatment – a dermatologist may recommend a skincare and melasma management routine that combines a variety of products and ingredients. They may also recommend combining at-home care with in-office treatments.

In-Office Treatments for Melasma

For patients who don’t achieve their desired results with at-home care alone, more advanced dermatologic procedures may be recommended. Some of the top in-office treatments for melasma include:

• Chemical peels – these topical treatments use precise, topical application of acids to remove dead, damaged skin and reveal healthy skin below. Chemical peels can be superficial or go deeper into the skin’s layers. Over the course of several treatments, melasma discoloration is improved, skin tone is brightened, and texture improves. In addition to these cosmetic benefits, chemical peels also open pores, allowing skincare products to be more fully absorbed.
• Microneedling – small needles are used to make microscopic injuries. This stimulates healing, increases collagen production, and improves pigmentation. Like chemical peels, microneedling can also improve the absorption of skincare products. For this reason, dermatologists may recommend combining microneedling with topicals.
• Laser treatments – laser treatments may be used to target hyperpigmented skin or to address vascular or inflammatory pigmentation concerns related to melasma. Overly aggressive laser treatments aren’t recommended, especially for those who have darker skin tone as they can lead to increased pigmentation rather than improving melasma symptoms.
• Combination therapy – combining dermatologic treatment with consistent at-home care is often the most effective way to achieve and maintain the desired results.

Preventing Melasma Flare-ups

Like managing most chronic skin conditions, prevention is the first and often most important step. Even with treatment, melasma flare-ups can recur, so it’s important to take steps to prevent flare-ups, including:

• Broad-spectrum sunscreen use – apply broad-spectrum sunscreen every day with an SPF of 30 or higher. Sunblock should be used every day even if it’s cold or cloudy. Reapply at least every two hours. A tinted, physical sunscreen with iron oxides protects against other forms of light exposure in addition to UV radiation, further improving melasma outcomes.
• Avoid light and heat – all forms of light and heat can worsen melasma flareups. Wear a wide-brimmed hat, seek shade regularly, avoid excessive temperatures, and limit time outdoors during sunny hours. This reduces the production of melanocytes that lead to melasma.
• Consistent skincare – follow your dermatologist’s recommended skincare routine that should include gentle cleansers, brightening serums, antioxidants, moisturizers, and sunscreen.
• Avoid irritation – Over exfoliation can damage the skin barrier triggering inflammation that worsens hyperpigmentation. Minimize use of exfoliants and harsh scrubs.

When to See a Dermatologist

Melasma may not require treatment. However, many patients choose to seek treatment to improve the appearance of discoloration. Because melasma can be persistent and sometimes difficult to manage with over-the-counter products alone, there are several situations where it may be helpful to consult a dermatologist, including:

• Needing a diagnosis to ensure the condition is melasma and not a more serious condition.
• Little to no improvement with over-the-counter skincare products and treatments.
• Avoiding treatments that could make melasma worse.
• Worsening pigmentation.
• Dark patches recuring after clearing up.
• Irritation following the use of over-the-counter treatments.
• Starting a personalized treatment plan to reduce dark spots.

Keep Skin Beautiful with a Melasma Management Plan

In conclusion, Dr. Martinez says, “While dark patches on the face can be frustrating, with the right, customized approach, melasma is manageable. Your dermatologist will support you in finding the best care products and steps at home as well as treatments to minimize the appearance of melasma patches.”

Schedule a Dermatology Consultation

If you’re interested in learning more about treatment options for melasma, take a few moments to schedule a consultation with a skilled dermatologist at U.S. Dermatology Partners. With answers to just a few quick questions, you’ll submit a scheduling request at a local practice, and our team members will be in touch to finalize the details.

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Edgar Martinez, MD