Melasma is a common pigmentation condition that causes brown or grey-brown patches, most often on the cheeks, forehead, upper lip, nose and jawline. It is more common in women and in people with naturally darker skin types, but it can affect anyone.
Melasma is not dangerous, but it can be persistent and frustrating. It is often triggered or worsened by ultraviolet light, visible light, heat, hormones, pregnancy, the contraceptive pill, hormone therapy and genetic tendency. Treatment usually requires a careful, long-term plan rather than a single quick fix.
At Atlas Dermatology, we assess the pattern and depth of pigmentation, your skin type, triggers, medical history and previous treatments before recommending a personalised treatment plan.
Available treatments
Sun and visible light protection
Strict light protection is the foundation of melasma treatment. Even small amounts of sun exposure, heat or visible light can worsen pigmentation or cause relapse.
We usually recommend:
- Daily broad-spectrum SPF 50+ sunscreen
- Tinted sunscreen containing iron oxides, especially for visible light protection
- Wide-brimmed hats and sunglasses
- Avoiding unnecessary heat and intense sun exposure
- Regular sunscreen reapplication when outdoors
Prescription creams
Prescription creams can reduce pigment production and help even the skin tone. These may include:
- Hydroquinone-based creams
- Combination creams, often containing hydroquinone, a retinoid and a mild anti-inflammatory ingredient
- Azelaic acid
- Retinoids
- Kojic acid, niacinamide or other pigment-regulating ingredients
- Topical tranexamic acid in selected cases
Hydroquinone and stronger prescription creams should be used under medical supervision, usually in treatment cycles, to reduce the risk of irritation or rebound pigmentation.
Tranexamic acid
Tranexamic acid can be helpful in selected patients with melasma. It may be used as a cream or, in some cases, as a tablet.
Oral tranexamic acid is not suitable for everyone and requires careful assessment, especially in people with a history of blood clots, stroke, clotting disorders, certain medications, or significant risk factors. When appropriate, it can be a useful part of a broader melasma management plan.
Chemical peels
Superficial chemical peels may help some patients, particularly when combined with prescription creams and strict sun protection. They need to be chosen carefully, as overly aggressive peels can worsen pigmentation, especially in darker skin types.
Laser and light-based treatments
Laser treatment for melasma must be approached cautiously. In some patients, certain low-energy laser treatments may be helpful, but inappropriate or aggressive laser treatment can worsen melasma.
Lasers are usually not the first step. They are best considered only after the skin has been prepared with medical therapy and after careful discussion of risks, benefits and realistic expectations.
Maintenance treatment
Melasma often improves with treatment but has a tendency to recur. Long-term maintenance is therefore very important and may include ongoing sun protection, intermittent prescription creams, gentle skin care and trigger avoidance.
Frequently Asked Questions
Can melasma be cured?
Melasma can often be improved significantly, but it is usually managed rather than permanently cured. Recurrence is common, particularly with sun exposure, heat or hormonal triggers.
Why did I get melasma?
Melasma is usually caused by a combination of genetic tendency, light exposure and hormonal factors. Pregnancy, the contraceptive pill and hormone therapy can contribute, but many people develop melasma without an obvious hormonal trigger.
What sunscreen is best for melasma?
A broad-spectrum SPF 50+ sunscreen is important, but tinted sunscreens containing iron oxides are often preferred because they also help protect against visible light, which can worsen melasma.
How long does treatment take?
Most treatments take several months to show meaningful improvement. Melasma improves gradually, and consistent treatment is more important than aggressive treatment.
Can I have laser treatment for melasma?
Sometimes, but laser is not suitable for everyone and can occasionally make melasma worse. A dermatologist can advise whether laser treatment is appropriate and when it should be considered.
Can melasma happen during pregnancy?
Yes. Melasma is common during pregnancy and is sometimes called “the mask of pregnancy”. Treatment options are more limited during pregnancy, so sun protection and pregnancy-safe skin care are especially important.
Will melasma come back?
It can. Even after good improvement, melasma may return with sun exposure, heat, hormonal changes or stopping maintenance treatment. A long-term prevention plan is usually needed.
Do over-the-counter brightening creams work?
Some may help mildly, especially ingredients such as thiamidol, niacinamide, vitamin C, azelaic acid or tranexamic acid. However, persistent melasma often needs prescription treatment and medical guidance.