Dermatology
What Causes Melasma?
Last reviewed: May 2026 · Haute MD Editorial Team
Melasma is a form of hyperpigmentation caused by overactive melanocytes (pigment-producing cells) in the skin. The primary triggers are UV exposure, hormonal changes (particularly estrogen and progesterone), and genetic predisposition. It appears as brown or gray-brown patches on the face, most commonly on the cheeks, forehead, upper lip, and nose.
Who gets melasma?
Melasma is most common in women — particularly those who are pregnant (called "the mask of pregnancy"), using hormonal birth control, or undergoing hormone replacement therapy. It can affect all skin tones but is more prevalent and visible in people with medium to dark skin tones.
What triggers melasma?
Sun exposure is the most significant trigger — UV light stimulates melanocyte activity. Heat (from saunas, hot yoga, cooking) can also trigger melasma independently of UV. Hormonal medications and pregnancy are major hormonal triggers.
How is melasma treated?
Melasma is treated with a combination of strict sun protection (broad-spectrum SPF 50+), topical depigmenting agents (hydroquinone, tranexamic acid, azelaic acid, kojic acid, retinoids), and in-office procedures such as chemical peels, laser treatments (with caution), and microneedling. Melasma is chronic and often recurs.
Frequently Asked Questions
Is melasma permanent?
Melasma can be significantly lightened but often recurs with sun exposure or hormonal changes. Consistent sun protection is essential to maintaining results.
Can laser treat melasma?
Laser treatment for melasma requires caution — aggressive lasers can worsen melasma in some patients. Low-energy, non-ablative lasers and picosecond devices are preferred. Treatment should be performed by a dermatologist experienced with melasma.
Does melasma go away after pregnancy?
Melasma that develops during pregnancy may fade after delivery and once breastfeeding is complete. However, it can become permanent in some women, especially with continued sun exposure.
What is the best cream for melasma?
Hydroquinone (2-4%) remains the gold standard topical treatment. Tranexamic acid is a newer, gentler alternative with growing evidence for efficacy. Both should be used under dermatologist supervision.
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