# 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.

Canonical: https://antiagingcare.org/blog/melasma-complete-guide
HTML version: https://antiagingcare.org/blog/melasma-complete-guide
Author: Anti Aging Care Editorial Team
Published: 2026-04-22
Updated: 2026-10-24
Category: Skin Conditions

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](https://pubmed.ncbi.nlm.nih.gov/38816973/)). 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](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/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](https://pubmed.ncbi.nlm.nih.gov/28374042/)). 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](https://pubmed.ncbi.nlm.nih.gov/37977681/)).
- **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](https://pubmed.ncbi.nlm.nih.gov/36897459/)). 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](https://pubmed.ncbi.nlm.nih.gov/38816973/)
- Kim HJ et al. Efficacy and safety of tranexamic acid in melasma: a meta-analysis. *Acta Derm Venereol*. 2017. [PubMed](https://pubmed.ncbi.nlm.nih.gov/28374042/)
- Sarkar R, Katoch S. Chemical peels in treatment of melasma. *Dermatol Clin*. 2024. [PubMed](https://pubmed.ncbi.nlm.nih.gov/37977681/)
- Feng J et al. Efficacy and safety of picosecond laser for melasma: a systematic review and meta-analysis. *Lasers Med Sci*. 2023. [PubMed](https://pubmed.ncbi.nlm.nih.gov/36897459/)
- American Academy of Dermatology. [Sunscreen FAQs](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/sunscreen-faqs)