Dermatologist's Guide to Your Best Skin

What is Melasma and How to Treat it

Melasma is one of the most common—and most maddening—skin conditions I treat. It shows up as flat, irregularly shaped patches of brown or grayish pigment, most often on the forehead, cheeks, upper lip and jawline. It can also appear on the forearms, neck, chest—basically, anywhere the sun touches. And yes, it’s the skin equivalent of an uninvited house guest: hard to predict, harder to manage and almost impossible to evict for good.

What Causes Melasma?

Melasma typically develops in women in their 30s and 40s, although it can show up earlier or later. It’s driven by a combination of:

  • Elevated estrogen levels (thanks to birth control pills, pregnancy and hormone therapy)
  • Sun exposure (especially UV and visible light)
  • Heat (yes, just heat—like from your oven or a hot yoga class)
  • Genetic predisposition (thanks, mom)

And it SUCKS. I say that professionally, of course. It’s a chronic condition with no cure. That means even if you successfully lighten it, it can come right back after a sunny afternoon walk or a round of IVF medication. Making treatment less about a cure and more about keeping it under control. So let's break down your treatment options.

Melasma Management 101: What Actually Works

Melasma is stubborn and there is no one clear cure all. You’ll need a combination of daily diligence, effective skincare and the occasional in-office intervention to keep things in check.

1. Limit Hormonal Triggers and Sun Exposure

Consider a non-hormonal birth control method as Melasma loves estrogen.

Avoid direct sun exposure—every single day, year-round.

Apply and reapply a zinc-based sunscreen (10% or more zinc oxide) every two hours. Non-negotiable. Have options in your purse, car and at work. Anywhere you may be there should be sunscreen, just buy your favorite three at a time (read my 2025 Dermatologist’s Sunscreen Guide on the blog for my top sunscreen recommendations).

Avoid direct sun and always wear a hat. Also consider installing UV protective film on your car windows and handheld fan to keep your skin from overheating as the heat can make your hands more brown.

2. At-Home Treatments That Help

There are a number of ingredients that can lighten pigmentation and/or slow its return, including melasma. Here are the ones I most frequently recommend. 

Mineral-based sunscreens

You want at least 10% zinc based sunscreen and ideally tinted with iron oxides that protect your skin from blue light which can activate your melasma as well. My favorite is Dermaquest but here are a few other good ones:

    • Dermaquest - SheerZinc Tinted Broad Spectrum SPF 30 in Nude
    • Suntegrity - Impeccable Skin, Broad Spectrum SPF 30
    • Minu - Brightening Sunscreen Minerals Broad Spectrum SPF 30 Gel-Cream
    • Pavise - Dynamic Age Defense
Skin-Lightening Creams 
    • Hydroquinone is the gold standard. It’s very effective, but not recommended to use year round and requires a prescription in the US. It is often prescribed as a combination cream with a retinoid and weak cortisone to minimize the risk of irritation. 
    • Patented by Beiersdorf, Eucerin’s Thiamidol is an over the counter option that is gentler and still effective.
Vitamin C serums

Provide an antioxidant shield limiting the free radicals that get to your skin and activate your melanocytes.

Cell turnover products
Oral Options
    • Tranexamic acid: A prescription option that reduces pigment formation from the inside out. Although over the counter in Europe, it requires a prescription in the US so speak to your dermatologist.
    • Polypodium leucotomos: A plant-based supplement that helps skin resist UV damage. Consider it your internal sunscreen support. The recommended dose is 480mg daily.
Other Options

Below are other ingredients that can help. Note, these don't help as much as the ones listed above, so I would not prioritize, but rather consider them more of an added bonus.

    • Topical Tranexamic
      • Acid shown to reduce melasma both orally and topically, but orally works significantly better. I have not found a topical version that does much. 
    • Kojic Acid
      • Naturally derived from fungi, mildly irritating and less effective than hydroquinone
    • Azelaic Acid
      • Anti-inflammatory and well tolerated, mildly effective for PIH and melasma
    • Arbutin (α- and β-arbutin)
      • A derivative of hydroquinone will a slower release, making it less irritating and less effective than hydroquinone
    • Licorice Root Extract (Glabridin)
      • Potent anti-inflammatory, well-tolerated in sensitive skin
    • Niacinamide (Vitamin B3)
      • Potent anti-inflammatory, well-tolerated in sensitive skin, improves skin barrier function making it better able to tolerate other treatments. 
    • Soy Extract (Serine Protease Inhibitors)
      • Often used in gentle brightening serums
    • Ellagic Acid
      • Antioxidant from from fruits (berries, pomegranates) that Inhibits brown formation
    • Cysteamine
      • Antioxidant and melanin production inhibitor but stinky and can be irritating.
    • Glutathione
      • Shifts melanin production with modest topical benefit.
Ingredients to avoid or use with caution
    • Mercury compounds – Illegal in many countries due to toxicity
    • Hydroquinone over 4% – Increased risk of rebound hyperpigmentation and irritation
    • Essential oils & DIY botanicals – High risk of irritation and can cause photosensitivity
3. In-Office Treatments I Recommend for Melasma Patients
  • A series of gentle chemical peels to exfoliate brown and brighten the skin without irritation and activating more brown.
  • Gentle resurfacing lasers (like Clear + Brilliant, LaseMD, even Fraxel or C02 with VERY LOW settings) to exfoliate without triggering a flare.
  • Ultra-short pulse duration lasers (like PicoSure) uses very short pulses of light to break down pigment particles in the skin. The short pulses minimizes damage to surrounding skin and reduces the risk of inflammation and activation of pigmentation. 
  • Aquagold facials with microdosing of neuromodulators and PRP directly into the skin to calm inflammation and lighten brown.
  • Treatments to AVOID with Melasma
    • IPL (Intense Pulsed Light): A classic melasma mistake. The heat can often make pigmentation worse.
    • Ablative or aggressive resurfacing lasers: Too much injury to the skin can cause hyperpigmentation and make melasma worse. Just say no!  

Hyperpigmentation vs Melasma vs Age Spots

While melasma is hormone and heat-driven, age spots (aka solar lentigines or liver spots) are your skin cashing in years of sun exposure. And hyperpigmentation? That's the catch-all term that covers both—and more.

Let’s break it down:

Hyperpigmentation

This is the umbrella term for any darkening of the skin due to increased melanin. It includes melasma, age spots, acne marks, bug bites, burns—you name it. If something triggers excess melanin production, it’s hyperpigmentation.

Think of it as the "what" not the "why."

Melasma

A specific type of hyperpigmentation caused by hormones and made worse by sun and heat. It usually shows up as symmetric patches on the cheeks, forehead, upper lip or jawline. What we have been discussing this whole time! 

Age Spots (aka Sun Spots or Solar Lentigines)

Flat, round brown spots that show up on sun-exposed skin like the face, hands and chest—especially after 40. These are caused by a genetic predisposition and cumulative UV damage---not hormones. The good news is they respond better to pigment-fading treatments and lasers than melasma but still have a tendency to come back. 

Final Thoughts

Melasma is frustrating, but with the right strategy you can manage it. The key is consistency, realistic expectations, and sun protection like it’s your job. The good news is your estrogen levels decrease in perimenopause and menopause and the melasma almost always improves. 

If you're unsure whether you're dealing with melasma, age spots, or something else like a possible skin cancer, see a board-certified dermatologist. Your skin deserves the truth—and a hat.

 

 

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