What Causes Melasma on Your Face, and How Can You Treat It?

Hyperpigmentation, in general, is a frustrating skin care issue to deal with, and melasma on the face can be particularly tricky to treat. For one thing, experts don’t know exactly what causes the common condition. Plus, there are a few unique factors at play that separate it from other kinds of dark spots. That’s why, if you want it to fade, you’re going to need a specific and strategic plan.

Melasma can affect pretty much anyone, although it’s much more common in women than men.¹ It also occurs in all skin tones, however, certain ethnic groups with higher pigmentation may be more susceptible—an important factor to consider if you’re caring for skin of color.²

There’s no cure for melasma but there’s better news if you have it and wish it would go away sooner rather than later: There are plenty of proven and effective ways to manage it. Here, dermatologists explain exactly what melasma on the face is, the causes behind it, and the best skin-brightening solutions for addressing it.

What is melasma? | Melasma causes | Melasma in darker skin tones | How to treat melasma on the face

What is melasma, exactly?

“Melasma is a pigmentary skin condition characterized by darkened patches that typically look brown or grayish,” Hayley Goldbach, MD, a board-certified dermatologist and assistant professor of dermatology at Brown University, tells SELF. “It most often appears on the face, particularly the cheeks, the forehead, and the upper lip.” (It can also crop up on parts of the body that are regularly exposed to the sun, such as the arms and neck, per the American Academy of Dermatology.)

The major difference, appearance-wise, separating it from other types of hyperpigmentation? Its presentation. “Whereas sun spots are more discreet and individual, melasma comes together in patches of darker skin that look irregular and blotchy,” Marisa Garshick, MD, a dermatologist at MDCS Dermatology and clinical assistant professor at Cornell University, tells SELF. This could be one small patch or several smaller ones that blend together into one larger area of discoloration, Dr. Garshick adds.

Melasma is fairly common; research shows that it affects anywhere from 1.5% to 33% of the population.¹ However, a whopping 90% of people who develop the condition are women, Nazanin Saedi, MD, a board-certified dermatologist in Philadelphia and a clinical associate professor at Thomas Jefferson University, tells SELF. “I’ve been practicing for 15 years and have only seen a handful of male melasma patients during that time,” she says. So why the gender bias? It has to do with the root causes of the issue….

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What causes melasma to show up?

Here’s the big caveat: All of the dermatologists SELF spoke with underscored the fact that there’s still a lot that we don’t know about melasma and, specifically, what causes it. Still, it’s clear that hormones are key players. Experts agree that both estrogen and progesterone are involved—exactly how remains to be discovered, but the theory is that increased levels of these hormones cause a surge in melanin (pigment) production, Dr. Saedi explains. “This is why melasma is so common in pregnancy. It’s reported that anywhere from 15 to 50% of pregnant people will develop it, and it’s even called ‘the mask of pregnancy,’” she adds.¹ (Similarly, folks on birth control pills may also get melasma.)³ But hormonal shifts are only one piece of the puzzle. Genetics are a factor too: “Around half of all melasma patients report having a family history of it,” Dr. Goldbach points out.

There’s also the sun-exposure factor: Ultraviolet rays trigger the production of melanin as a protective mechanism.⁴ In short, that means that the sun plays a part in any and all types of hyperpigmentation. In the case of melasma, there’s an interplay with those aforementioned hormonal changes that have already revved up melanin production, says Dr. Goldbach. “It’s why melasma shows up on the most sun-exposed areas of the face and why it’s worse in the summer than in the winter,” adds Dr. Saedi.

But natural light isn’t the only culprit. High-energy visible light, or blue light, which is emitted both by the sun and the screens of our beloved electronic devices, has also been shown to exacerbate melasma, Dr. Garshick notes; it kicks pigment-producing cells known as melanocytes into overdrive so that they pump out more melanin, she adds.⁵

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Are certain skin tones more prone to melasma?

Yes. “Melasma tends to occur more in people with darker skin, and specifically women of Southeast Asian descent,” says Dr. Saedi. (Although she notes that, per the available data, it either doesn’t occur or is not reported as often in Black folks compared to other darker-skinned populations.) Again, the exact reason for this connection is unknown, but it likely has something to do with the fact that people with deeper skin tones produce more melanin in general, coupled with how their bodies respond to pigment-producing stimuli, she says.

Melasma will look different in someone with a lighter skin tone versus a deeper one, but the level of darkening remains relative to the person’s base tone, and the hyperpigmentation shows up in the same type of blotchy patches and appears in the same areas, according to the dermatologists we consulted. Some treatment options do need to be tailored slightly based on skin color, however. (More dark-skin tips for ya in a moment.)

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How to treat melasma on the face

As we mentioned, there’s no known cure for melasma. If it appears during pregnancy, it may regress or even disappear entirely after you give birth, but you’ll still be more susceptible to it in the future, Dr. Garshick says. That’s understandably frustrating and challenging: “Dealing with melasma can often feel like you’re walking up a downward escalator, especially during the summer,” she adds. That’s largely because, unlike other types of hyperpigmentation, the pigment can be found both in the epidermal (the more superficial) layer of the skin and the deeper dermal layer, Dr. Saedi explains, making it harder to target.⁶ You won’t be able to tell by looking at your skin, but your dermatologist can use a device called a Wood’s lamp to help determine the depth of your dark spots.

Challenges aside, there are plenty of tried-and-true ways to manage the condition. Before we get into those, though, note that the doctors we talked to strongly advise against googling “melasma home remedies.” Sorry, but there’s no solid research showing that smearing yogurt or coconut oil on your face, for example, can brighten dark spots. Plus, it’s important to seek the help of a board-certified dermatologist, if you can, since they’ll be able to both properly diagnose you and tailor an effective treatment plan to your individual needs, Dr. Garshick warns. That being said, here are some general strategies to consider:

Be extra vigilant about sun protection.

Any amount of sun exposure can both trigger and/or exacerbate melasma, so now is certainly not the time to slack on your SPF game. While any sunscreen is better than none, all of the dermatologists we spoke with suggest looking for mineral options, since chemical sunscreens absorb the heat from UV rays, which may make your dark spots worse. You also want a product that specifies “broad-spectrum” protection and, ideally, contains iron oxides, which have been shown to shield the skin from blue light.⁶ (FYI, you’re most likely to find these ingredients in tinted formulas.)

Both Dr. Garshick and Dr. Saedi are fans of Colorescience’s Sunforgettable Total Protection Face Shield SPF 50 ($43, Amazon). Dr. Garshick also likes Neutrogena’s Mineral UV Tint Face Liquid Sunscreen SPF 30 ($17, Target). The added perk of using tinted SPF? It can help camouflage your melasma while it protects your skin, she says.

No matter which sunscreen you choose, make sure to reapply it every two to three hours, and consider wearing a wide-brimmed hat and utilizing UPF clothing as well—these are all smart ways to further protect your skin from UV radiation, per the Skin Cancer Foundation.

Consider topical skin-brightening ingredients.

Another caveat: If you’re trying to treat melasma while pregnant, your options are going to be somewhat limited. The above sunscreen plan is a great start, of course, but as far as topical ingredients go, the ones that have been shown to be effective and safe during pregnancy are somewhat limited. One exception to try: azelaic acid. “It inhibits melanocytes from producing pigment, and it’s available in both over-the-counter and prescription-strength products,” says Dr. Goldbach. You can ask a dermatologist about a prescription and these are a couple of OTC products you can consider:

The Ordinary Azelaic Acid Suspension 10% ($10, The Ordinary)

Paula’s Choice Boost 10% Azelaic Acid Booster ($36, Amazon)

For non-pregnant folks, a prescription cream that combines tretinoin, hydroquinone, and a steroid is one of the most common courses of melasma treatment, according to Dr. Saedi. Hydroquinone is admittedly controversial (it’s a common skin allergen and, in rare cases, can cause a paradoxical discoloration of the skin known as ochronosis, if used incorrectly), so you should definitely talk to a dermatologist before using it. And if you want an alternative, tranexamic acid is another buzzy skin-brightening ingredient. “Oral tranexamic acid is really helpful for the treatment of melasma,” says Dr. Golbach. “We don’t know the exact mechanism of action, but we think it may disrupt the interaction between melanocytes and the pigment they pass to the rest of the skin.” (An important caveat: You can’t take it if you’re also on birth control pills or if you have a history of blood clots.)

Dr. Garshick agrees, noting that tranexamic acid may impact a potential vascular component of melasma: “We don’t know why, but when we’ve biopsied skin that has melasma we see that it has an increased prominence of blood vessels. Oral tranexamic acid may affect this somehow,” she says. TXA, as it’s called, can also be used topically. For example, Dr. Saedi says her melasma patients have seen good results from both SkinCeuticals Discoloration Defense ($108, Dermstore) and Alastin A-luminate Brightening Serum ($168, Alastin).

Consider in-office treatments.

In addition to a topical skin care regimen, certain in-office procedures can also be very helpful. Not surprisingly, the choices are limited for pregnant people, although Dr. Garshick says light chemical peels using glycolic acid and lactic acid can help. These exfoliating ingredients lighten and brighten the surface of the skin as well as inhibit tyrosinase, an enzyme needed for melanin production, she says.⁷

Not with child? Stronger chemical peels, specifically ones using TCA (trichloroacetic acid, a powerful exfoliant), can be very effective, says Dr. Goldbach.⁸ Microneedling in combination with either PRP (platelet-rich plasma, derived from your own blood) or tranexamic acid is another promising option; the procedure, which involves puncturing your face with teeny needles, can help those ingredients get deeper into the skin, says Dr. Garshick (a big benefit when the pigment isn’t just superficial).^{9 10}

Lasers are another—potentially—helpful treatment, though it’s important to proceed with caution. “We don’t exactly know why, but heat can exacerbate melasma,” says Dr. Saedi, and many lasers generate heat. IPL, for example, is a bad idea; it may improve the condition temporarily, but later end up making the discoloration darker, she warns. She adds that Pico lasers, which don’t generate heat and have a specific wavelength to target pigmentation, are one good alternative.¹¹ Dr. Garshick agrees, noting that light resurfacing lasers, such as Clear & Brilliant, are also worth considering.

Just keep in mind that not all lasers are appropriate for all skin tones; some carry an increased risk of post-inflammatory hyperpigmentation in darker complexions, she says.¹² The takeaway: It’s important to see an experienced dermatologist who knows how to treat melasma. Make sure they’re board-certified, for one thing, and that they both have and use a variety of different lasers in their office, she adds. It’s also a smart move to ask about their experience with melasma, specifically, and request to see before and after photos.

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As Dr. Garshick puts it: “You can never really let your guard down when it comes to treating melasma. Prevention and maintenance are just as important.” A little, uh, dark, yes, but we’re choosing to look on the bright side: By following the expert advice above —and working closely with a dermatologist—you can absolutely expect to see an improvement and a more even complexion.

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