Melasma: Causes, Types and Treatments That Work
A complete guide to melasma: triggers, epidermal vs dermal types, sunscreen and visible-light protection, topicals, tranexamic acid, peels and lasers, and how to prevent relapse.
Melasma is a common, chronic condition that causes brown or gray-brown patches, usually on the cheeks, forehead, upper lip and chin. The short answer: it can be improved but tends to come back, so treatment is about control. Strict sun protection, including from visible light, is the foundation; topical treatments come next; tranexamic acid, peels and selected lasers are add-ons under a dermatologist's care.
What causes melasma
- Sunlight, including visible light
- Hormones: pregnancy, birth control pills and hormone therapy
- Genetics: more common in people with medium to darker skin tones
- Heat and some medicines or cosmetics that irritate skin
It's more common in women but also affects men.
Types
Melasma pigment can sit in the epidermis, the dermis or both (mixed). A 2024 review notes that melasma involves changes beyond pigment, such as in blood vessels and the basement membrane, which supports combination treatment (Jo et al., Ann Dermatol, 2024). Dermal and mixed types respond more slowly.
Step 1: Sun and visible-light protection
Use broad-spectrum SPF 30 or higher daily and reapply outdoors (AAD: sunscreen FAQs). Tinted mineral sunscreens containing iron oxides also block some visible light, and dermatologists often recommend them for melasma. Hats and shade help too.
Step 2: Topical treatments
| Ingredient | Role |
|---|---|
| Hydroquinone (prescription in the US) | Long-standing first-line lightener; used in limited courses |
| Triple-combination cream | Hydroquinone, tretinoin and a mild steroid; prescription |
| Azelaic acid | Option for sensitive skin |
| Tranexamic acid, cysteamine, thiamidol, niacinamide, kojic acid | Additional or maintenance options |
Tranexamic acid
A meta-analysis found tranexamic acid reduced melasma severity scores, both alone and when added to routine treatment, with minor side effects in the included studies (Kim et al., Acta Derm Venereol, 2017). Oral tranexamic acid is a prescription medicine and isn't right for people with clotting risks, so it needs a doctor's evaluation.
Peels and lasers
- Chemical peels are described in reviews as additional or maintenance therapy for melasma (Sarkar and Katoch, Dermatol Clin, 2024).
- Lasers: a meta-analysis found 1064 nm picosecond laser safe and effective, while 755 nm picosecond laser was not superior to topical agents and caused post-inflammatory hyperpigmentation in some patients (Feng et al., Lasers Med Sci, 2023). Aggressive lasers can worsen melasma.
Pregnancy and birth control
Melasma often appears in pregnancy and may fade afterward. Many treatments, including oral tranexamic acid and retinoids, are avoided during pregnancy; sun protection is safe. If birth control seems to trigger it, discuss options with your doctor.
Preventing relapse
- Year-round sun protection
- Maintenance topicals
- Avoid heat and irritating products
- Expect flares in summer
Frequently asked questions
Is melasma permanent? It can fade, especially after pregnancy, but often recurs.
Can men get melasma? Yes.
Is it dangerous? No, but have new or changing spots checked to rule out other conditions.
How long does treatment take? Usually months.
This article is for educational purposes only and is not medical advice. Talk to a board-certified dermatologist or your doctor about your situation.
Sources
- Jo JY et al. Update on melasma treatments. Ann Dermatol. 2024. PubMed
- Kim HJ et al. Efficacy and safety of tranexamic acid in melasma: a meta-analysis. Acta Derm Venereol. 2017. PubMed
- Sarkar R, Katoch S. Chemical peels in treatment of melasma. Dermatol Clin. 2024. PubMed
- Feng J et al. Efficacy and safety of picosecond laser for melasma: a systematic review and meta-analysis. Lasers Med Sci. 2023. PubMed
- American Academy of Dermatology. Sunscreen FAQs
