skin-concerns
What Is Melasma?
Last reviewed: May 2026 · Haute MD Editorial Team
Melasma is a common hyperpigmentation condition causing brown or gray-brown patches on the face — most commonly on the cheeks, forehead, upper lip, and chin. It is caused by overactive melanocytes (pigment-producing cells) triggered by UV exposure, hormonal influences (pregnancy, oral contraceptives, hormone replacement therapy), and heat. It predominantly affects women (90% of cases) and people with Fitzpatrick skin types III-VI (olive to darker skin tones). Melasma is chronic — it can fade with treatment but tends to recur with sun exposure or hormonal changes.
What drives melasma
Three factors drive melasma — UV radiation (which stimulates melanocytes and is the primary trigger for recurrence), hormones (estrogen and progesterone stimulate melanocyte activity — explaining the high prevalence during pregnancy and with hormonal contraceptives), and heat (infrared radiation and heat sources can independently trigger melanocyte activation, which is why visible light and infrared blocking tinted sunscreens are more effective than UV-only protection in melasma patients).
Treatments that actually work
Hydroquinone (2-4%) is the most studied depigmenting agent — it inhibits tyrosinase, the enzyme driving melanin production. It is highly effective but should be used cyclically (3 months on, 1-2 months off) to prevent paradoxical ochronosis (rare darkening with prolonged use). Tretinoin accelerates cell turnover and enhances hydroquinone penetration. Tranexamic acid (oral 250mg twice daily or topical) is increasingly evidence-based and well tolerated. Chemical peels (glycolic acid, salicylic acid, mandelic acid) remove surface pigment. Laser and IPL can worsen melasma in darker skin tones — very careful patient selection required.
The sunscreen principle — non-negotiable
No melasma treatment works without simultaneous rigorous sun protection. UV exposure — even brief, incidental exposure on a cloudy day — triggers melanocyte activity and undoes weeks of treatment. Tinted (iron oxide-containing) sunscreen SPF 50+ is superior to non-tinted formulas for melasma because iron oxide blocks visible light, which also stimulates melanocytes. Apply every morning, reapply during outdoor exposure, and wear broad-brim hats.
Frequently Asked Questions
Does melasma go away on its own?
Pregnancy-related melasma (chloasma) often fades significantly within several months of delivery and discontinuation of hormonal influences. Non-pregnancy melasma persists without treatment. With treatment and rigorous sun protection, melasma can fade substantially but tends to recur with UV exposure or hormonal changes.
Can melasma be permanently removed?
Melasma cannot be permanently eliminated — it is a chronic condition driven by overactive but otherwise functional melanocytes. Treatment fades existing pigment and controls new pigment formation, but ongoing maintenance (daily sunscreen, maintenance topicals) is required to prevent recurrence.
Is laser safe for melasma?
Laser treatment for melasma requires caution — aggressive laser or IPL can cause post-inflammatory hyperpigmentation (PIH), particularly in skin types III-VI. The safest approach uses low-fluence lasers by experienced providers familiar with melasma. Laser should complement, not replace, topical treatment and sun protection.
Does vitamin C help melasma?
Vitamin C (ascorbic acid) has antioxidant properties and modestly inhibits tyrosinase — it can support melasma treatment as an adjunct but is not potent enough as a standalone treatment. L-ascorbic acid at 15-20% concentration is the most effective form. It is useful as a morning antioxidant serum under SPF.
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