10 Effective Melasma Treatment Options

You may or may not have heard of Melasma, but you have no doubt seen it, as it is one of the most common skin conditions. I come across numerous cases of Melasma seeking advice and treatment. Its manifestation as the appearance of dark patches on skin, especially the face, can become a source of frustration and impacts one’s confidence and self-esteem. It is not unusual for my patients to feel self-conscious due to this stubborn pigmentation issue and seek effective treatment options.

In this article, I’ll try to help you understand this skin condition and dispel doubts about it. We will explore the impact melasma has, not just on the skin, but on an individual’s psychology as well, as I’ve seen with a majority of my patients. Finally, I’ll guide you through the various treatment options available and a few home remedies that can be used to improve your skin.

Let’s get started.

What is Melasma?

On the surface, melasma is a skin condition which is easily identifiable as dark patches on the skin. Interestingly, these patches very often appear symmetrically on the face, more so on the cheeks, forehead, bridge of the nose and above the lip. The range of pigmentation ranges from shades of light brown to a dusky grey-brown. Other exposed areas of the skin are also prone to melasma like the neck, and forearms.

Other than the appearance of darker spots and patches on the skin, it is mostly harmless to the human body. However, it has a much greater impact on patients’ emotional well-being as documented in many studies. I have found many instances where patients misidentify it as age spots, sun damage or other kinds of hyperpigmentation, which can cause unnecessary anxiety. This is where the real danger of melasma lies as it can significantly affect one’s quality of life.

It affects 5-6 million people in the USA alone with its incidence varying greatly between people of different ethnicities. Women from southeast asian countries are highly prone to this with over 40% cases. There is a clear connection between genetics and melasma. Hormonal changes are also linked to it, as it often develops or worsens during pregnancy (as high as 50% cases). Exposure to UV rays from the sun is also cited as a cause.

The underlying mechanisms that cause it involve a host of factors including pigments, hormones, UV rays and the environment. In all, melasma has a complex character in terms of both appearance, causes and effects. That is why I always stress that a proper diagnosis is crucial in coming up with a treatment plan and goes a long way in bringing health and confidence back to patients struggling with this skin condition.

What Causes Melasma?

With the advanced research around the topic, we have a good understanding of the exact reasons behind melasma. There isn’t a single cause that we can point to but a host of internal and external factors that combine to bring about these dark patches. There is definite evidence that certain factors influence this skin condition greatly, however, in most cases, I have observed the presence of more than one contributing factor. The most common causes are:

UV Rays

One of its primary causes is exposure to Ultraviolet (UV) radiation from sunlight. Energy from the sun triggers melanocytes in the exposed areas of the skin to produce more melanin, the pigment that protects the skin but also makes it darker. I have seen many patients who presented the typical dark pigmentation after prolonged exposure to the sun. The direct connection between UV exposure and melasma is well researched.

Hormonal Changes

Hormones also play a significant role in the appearance of melasma. Changes in the levels of oestrogen and progesterone, especially during pregnancy, can trigger or intensify it. For this reason, it is often referred to as ‘the mask of pregnancy’. Similar effects can be seen with the use of birth control pills and hormone replacement therapy, which also contribute to hormonal fluctuations. I have reassured many mothers-to-be that their melasma would disappear after the baby is born and their bodies regulate the hormonal balance.

Genetics

Research into the prevalence of melasma has revealed that it is very likely to be influenced by genetics. It is not uncommon for generations in a family to be affected by it, pointing to its hereditary nature. So, having a family history of melasma will make you more susceptible to it.

Side-effect of Medications

Certain medications can also cause melasma. Anti-seizure drugs and some antibiotics, for example, can increase the skin’s sensitivity to sunlight. This makes it more prone to melasma development. Talk to your doctor if dark spots on your skin appear after you start taking prescribed medication.

Skincare Products

It may come as a surprise that some skincare products, that are meant to make your skin better, can also trigger melasma. Mostly, any irritation caused by ingredients in skin care products may bring about increased pigmentation. You should take care to choose gentle, non-irritating formulations especially if you have a family history of melasma, sensitive skin or are expecting. You can consider options like Trqois Terra Kudzu-based Face Cream with SPF-15 which has soothing ingredients and provides all day long UV protection.

Who is Most Likely to get Melasma?

Melasma affects people everywhere, however, some individuals are more likely to get it. Certain factors may make their skin more prone to the changes that cause melasma.

Women

Melasma affects women in a far greater proportion than men. This is majorly due to the influence of female hormones. Hormonal shifts that come with menstruation, pregnancy, and menopause can all play a role in activating melasma.

Dark Skin

People with darker skin tones, especially those who fall under Fitzpatrick skin types III-VI, are more prone to melasma. Melanocytes in these persons are naturally more active, producing more melanin even without external stimulation. This makes them more likely targets of hyperpigmentation or melasma.

Family History

As we discussed above, melasma runs in families. The genetics of an individual have a large say in whether they will get melasma. So, if anyone in your family has had melasma, you are at a high risk of getting affected as well.

If we look at the distribution of melasma in different populations, we see that it is quite common in Latin americans.

Treatment Options

Melasma can be persistent and challenging to treat completely. There’s no magic bullet, no overnight cure. However, over my career as a dermatologist, I’ve witnessed significant improvements in patients’ skin through a combination of personalised and targeted treatments. Finding and tailoring the right approach for each individual is the most effective treatment for melasma.

The treatment options available today are:

Topical Treatments

These are applied directly to the affected areas of the skin and are often the first intervention I suggest.

Hydroquinone: In my experience, hydroquinone is the first and most effective melasma treatment option. It inhibits tyrosinase, which is an enzyme which is needed for producing melanin. However, this should be used under the guidance of a dermatologist. I typically advise short-term, and controlled use as continued use may cause skin darkening.

Tretinoin: This is a derivative of Vitamin A. It promotes skin cell turnover which means pigmented cells are discarded faster and a fresher layer of skin from underneath is revealed. Usually, this is prescribed with hydroquinone, as they work great together.

Corticosteroids: The main action of corticosteroids is to soothe inflammation which often causes melasma. Even though these are great for reducing irritation and redness, long-term use can make the skin thin, so care and monitoring is needed when using this. Triple combination creams which contain hydroquinone, tretinoin and corticosteroids perform really well.

Azelaic Acid & Kojic Acid: For patients with sensitive skin, or those who can’t tolerate hydroquinone, azelaic acid and kojic acid are great alternatives. They also inhibit tyrosinase, but their effects are milder than hydroquinone. I find these options helpful for maintaining results achieved with stronger treatments.

Tranexamic Acid: This is a newer option which was used for controlling bleeding but has shown great results in treating melasma. It inhibits plasmin, an enzyme that helps in melanocyte activation. This reduces melanin production which helps relieve melasma. It can also be taken orally.

Chemical Peels

In case of epidermal melasma, where darkening pigment is located on the top layer of the skin, chemical peels are very helpful. These work by removing the top layers of the skin and bringing out the layers of skin underneath. There are different options here too.

Glycolic Acid Peels: Derived from sugarcane, glycolic acid is a common ingredient in chemical peels that are used for treating melasma. Their exfoliating action promotes cell turnover and pigment reduction. I often recommend a series of peels spaced over several weeks.

Other Peel Options: Salicylic acid, trichloroacetic acid (TCA), and Jessner peels are other options that can be tailored to patients’ needs. The choice of peel depends on the depth of the melasma and the patient’s skin type.

Laser / Light Therapy

Laser and light therapies use targeted energy to break down excess melanin. These treatments require specialised equipment and expertise. However, they may carry risks of post-inflammatory hyperpigmentation and are generally less effective than topical treatments.

Intense Pulsed Light (IPL): Broad-spectrum light is used to target melanin, breaking it into smaller particles that the body can eliminate. However, IPL can sometimes trigger post-inflammatory hyperpigmentation, especially in darker skin tones. Patients have to be screened and equipment calibrated carefully to reduce this risk.

Fractional Lasers: These create very small injuries in the skin, which stimulates collagen healing which improves skin tone and texture. I often recommend fractional lasers for patients with deeper dermal melasma, where the pigment has lodged deeper in the skin.

Q-Switched Lasers: Q-switched lasers deliver very short pulses of high-energy, targeting melanin without damaging the surrounding skin. These lasers are generally safe for all skin types, but a high level of expertise is crucial for safe treatment.

Microneedling

Similar to fractional lasers, microneedling creates tiny punctures in the skin using very, very fine needles. The healing process that follows stimulates collagen production and improves the action of topical treatments.

Tranexamic acid or Vitamin C based topical treatments can show greater effectiveness when used in conjunction with microneedling.

Natural Remedies for Melasma

A quick internet search will overwhelm you with a plethora of natural remedies and their skin benefits. However, I would encourage everyone to try them with caution. The best option is to discuss their use with your dermatologist, as some common remedies may cause skin irritation making your melasma worse.

• Saffron with Milk: Loaded with antioxidants like crocin, Saffron may help reduce melanin production, thereby lightening dark spots associated with melasma. It also has anti-inflammatory properties that can soothe the skin. Milk, rich in lactic acid, acts as an exfoliant which helps in removing dead skin cells. To use this combo, soak a few strands of saffron in a bowl of milk for around 30 minutes. Use a ball of cotton or your fingers to apply over affected areas. Rinse it off with lukewarm water after 15-20 minutes.
• Turmeric and Yoghurt: Lactic acid in yoghurt is a gentle exfoliator and may help lighten dark spots. The active compound curcumin in turmeric has anti-inflammatory and antioxidant properties that can help reduce melanin production. Mix turmeric powder with yoghurt to form a paste, apply it to the affected areas, and leave it on for 15-20 minutes before rinsing off. Regular use can lead to smooth skin with even tone.
• Honey with Lemon Juice: Known for its natural bleaching properties due to high citric acid content, lemon juice can help lighten melasma spots. Apply freshly squeezed lemon juice mixed with honey directly to the affected areas for about 15 minutes before rinsing off. However, be cautious as lemon juice can increase sun sensitivity; always apply sunscreen afterward.
• Other Natural Remedies: Cold compress along with the above remedies helps with better results. Ingredients like aloe vera, licorice extract, and soy have shown some potential in research, but further studies are needed to confirm their efficacy and safety.

While these natural remedies may provide some benefits, consistency is key, and results may take time to become visible. If melasma persists or worsens despite home treatments, I would suggest consulting a dermatologist immediately for personalized treatment options.

Preventing Melasma

The age old adage of ‘prevention is better than cure’ stands true with melasma. We have explored the various ways melasma works. This allows us to plan for protection against it.

• Protection from Sun: It is an absolute must to use sunscreen on a daily basis. A broad-spectrum sunscreen with SPF of 30 or higher will go a long way to prevent melasma. Remember to reapply every two hours, and especially after swimming or sweating. Clothing like wide hats, long-sleeved tops and sunglasses will give you additional shielding from direct sunlight, particularly during peak hours when UV rays are the strongest, is always good, studies have found.
• Hormonal Awareness: When considering hormonal birth control or hormone replacement therapy, discuss its likely impact with your doctor. Sometimes, adjusting the type or dosage of hormones can minimise the risk of triggering melasma.
• Gentle Skincare: Choosing mild cleansers and moisturisers that do not irritate your skin also reduces the risk of melasma. Harsh scrubs or exfoliators may make your melasma worse. You can’t go wrong with products formulated for sensitive skin and those without potential irritants. If in doubt, check in with your dermatologist to help you select the best skincare products for you. You can also learn more about choosing the right skincare ingredients in this article comparing niacinamide and collagen.
• Lifestyle Changes: Some studies suggest that stress may contribute to melasma. Engaging in stress-reduction techniques such as meditation or yoga may be beneficial. Maintain a balanced diet rich in antioxidants and stay hydrated to support overall skin health.
• Regular Dermatological Check-ups: Regular consultations with a dermatologist can help create a skincare routine based on your needs and monitor any changes in your skin condition. Early intervention can be crucial for managing melasma effectively.

Living with Melasma

Melasma is often a chronic condition, which requires continued management and long-term preventative measures. Even with treatment, it can recur, especially with sun exposure or hormonal fluctuations. I cannot stress enough the importance of being patient and understanding that progress may be gradual.

As I tell my patients, don’t let melasma define you. When you adopt a proactive approach, combining effective treatments and prevention routine, you can significantly improve your skin tone. Remember, you’re not alone. Millions of people struggle with melasma, and with the right guidance and support, you can find your way to a clearer, healthier complexion. A dermatologist can provide personalised recommendations based on your specific needs. Don’t hesitate to seek professional advice. It’s an investment in your skin and your well-being.