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Melasma - its causes, signs, and treatments

This page was updated on Wed, Nov 06, 2019

What is Melasma?

Melasma is a pigment problem of facial skin.

What causes melasma?

The exact cause is unknown but hormones, sun damage and genetics play a role. We know that UV rays cause pigment cells in the skin, called melanocytes, to make too much pigment. Visible light, such as from indoor lighting, can cause it too. Cells in the skin, called melanophages, gobble the pigment up and hold it in the skin. Normally pigment fades, but these cells store it so the color does not go away easily. There are also more capillaries in the parts of skin with melasma and other cells in the skin are more active, such as dermal fibroblasts. All this means that melasma is complex and we have not figured out entirely what is going on – but the skin is very busy!

What role to hormones and birth control pills and pregnancy play in melasma?

Hormones make melasma worse, but we don’t know how and why. It is not the level of hormones that is the issue, it is some other mechanism.

Who gets melasma?

9% of women will have melasma at some point in their lives, especially during their reproductive years. Most people with melasma are women, but men can get it too.

What are the signs of melasma?

Hyperpigmentation of patches of skin on the central forehead, above the eyebrows, on the cheek bones, upper lips, and side of the face. Melasma typically does not cause pigment of the skin within the eye socket, below the jaw bone, on the tip of the nose or down the sides of the neck. Patches of melasma hyperpigmentation are curved and not straight.

What hyperpigmentation skin problems can mimic melasma?

  • Pigment down the sides of the neck may look like melasma but it is more likely to be Poikiloderma of Civatte, a form of hyperpigmented sun damage.
  • Sun spots are typically discrete and present asymmetrically in parts of skin that has had a lot of sun exposure.
  • Drug induced hyperpigmentation and lichen planus pigmentosis (you need to go to a dermatologist for these diagnosis)
  • Post-inflammatory hyperpigmentation from healed acne lesions, injuries or rashes.

What is the best skin treatment for melasma?

Your skin care routine is the best way to get rid of melasma. Use,

Skin lighteners that are tyrosinase inhibitors.

These products will reduce melanocyte melanin production. The best choices are hydroquinone and the botanical lightners arbutin, kojic acid. Azelaic acid works too but can be irritating. Of these, hydroquinone works the best. It is found with the botanical lighteners in my Pigment Fading Pads. Vitamin C, as in my Vitamin C Anti-Wrinkle Serum, will help inhibit tyrosinase too.

Ingredients that exfoliate skin, reduce sun damage and turn down tyrosinase.

The tyrosinase inhibitors will penetrate skin better if you also use retinol and glycolic acid products such as my Retinol Anti-Wrinkle Night Cream and Glycolic Acid Face Cream. These two ingredients also down regulate (turn down) tyrosinase and increase skin cell turnover to help shed pigment.

Broad spectrum sunscreen with SPF 30+ and products with iron oxide over 3.2%

It is really important to block UV rays that lead to pigment formation. You need to block visible rays too and you do that with products that contain 3.2% or more iron oxide. My Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen gives you both UV and visible light protection. Top it with mineral powder for even more protection.

What is the best skin care routine to fix melasma?

Remember you get the best results with Complete Skin Care. Dr. Bailey’s Complete Skin Care involves the 4 essential skin care steps of,

  1. Cleanse
  2. Correct
  3. Hydrate
  4. Protect.

CLEANSE skin with a gentle cleanser. Use a non-irritating toner will help remove any residual dirt and skin oil to enhance penetration of products as well.

CORRECT with Pigment Fading Pads followed by either Vitamin C or Glycolic Acid as in my Vitamin C Anti-Wrinkle Serum™ or Glycolic Acid Anti-Wrinkle Cream. At night use a retinoid such as a my Retinol Intensive Anti-Wrinkle Night Cream. Because inflammation may drive melasma, I add Green Tea Antioxidant Therapy™ an important product to help calm inflammation naturally and safely.

HYDRATE to balance skin moisture and help your skin tolerate this intensive treatment routine. Use a product matched to your skin type but without conflicting ingredients to your correcting products.

PROTECT skin from UV and visible light using a broad spectrum zinc oxide sunscreen and a product with 3.2% or more iron oxide. My Sheer Strength Pure Physical Matte Tinted SPF 50+ Sunscreen gives you both and is the best choice for melasma. If makeup is worn, use mineral makeup powder to enhance sun protection. Some powders, such as my Pressed Mineral Makeup Powder have a lot of iron oxide to help block visible light too. 

Does this sound overwhelming? It can be. I’ve created my Ultimate Pigment and Sun Damage Repair Kit to take out the guess work. Once your skin is tolerating these products, you can add the Vitamin C Serum.

How long does it take for melasma to improve?

Once you start a good skin care routine to fight melasma, improvement time will vary for each person. Sometimes results happen quickly, other times the struggle takes much longer. Laser and skin care procedures don’t often help and the most important treatment is a good skin care routine. This is why an intensive skin care routine is important.


Shankar Krupa, et. al., Evidence-Based Treatment for Melasma: Expert Opinion and a Review, Dermatol Ther, 2014 Ded; 4(2): 165-186

Melasma, American Academy of Dermatology, 2018