With summer round the corner, it’s worth remembering that this can be a very distressing time of year for people with melasma. This is a chronic skin condition that normally affects the face and often gets worse with sun exposure. It generally presents as very visible uneven brown or greyish patches of hyperpigmentation on the cheeks, upper lip or forehead. Even worse, melasma on the face is notoriously difficult to get rid of despite the seemingly endless number of treatments available on the market. In this article, we’ll review the best skincare, prescription and medical treatments that can actually help you get rid of melasma and prevent flareups.
What is Melasma & What Causes it?
First thing’s first, its worth defining this condition. Melasma is a type of hyperpigmentation. It typically presents as symmetrical large brown or grey-brown patches on sun-exposed areas of the face such as the cheeks, upper lip, forehead and bridge of the nose. It can also affect the neck. Melasma occurs due to an overproduction of melanin (the pigment responsible for skin colour). Whilst anyone can get it, melasma is 9X more common in women and people with medium or darker skin tones. Although melasma is harmless, it can be distressing for sufferers due to its prominent location on the face and because it’s often recurring and slow to respond to treatment.
Whilst there isn’t a definitive cause of melasma, there are a number of factors that can trigger and worsen it. Understanding these is the most important step to treating and preventing melasma. The key triggers for getting melasma on the face include:
- UV & Visible Light Exposure: Sun exposure is probably the most significant trigger. The ultraviolet (UV) radiation stimulates melanocytes (the cells responsible for melanin production). This leads to patchy pigmentation. Even visible light (particularly the blue light wavelength) and heat can make melasma worse.
- Hormonal Changes: Melasma commonly develops during pregnancy with up to 50% of pregnant women getting it. In fact this association is so strong that its often called the “mask of pregnancy”. Oral contraceptives and hormone replacement therapy (HRT) can also trigger it. Whilst we don’t know the exact mechanism that causes this, it may be due to oestrogen and progesterone stimulating pigment cells.
- Genetics: There’s a strong link between genetics and getting melasma. People with darker skin types (Fitzpatrick skin types III–VI) are more prone to melasma due to higher baseline melanin activity. You’re also more liklety to get melasma if you’re a woman or have a family history of it.
- Skin Irritation: Whilst this isn’t a cause, certain skin irritants can trigger flareups. Overuse of exfoliants, fragrance-heavy products or harsh treatments (like strong peels or lasers) can provoke melasma in people susceptible to it.
How to Get Rid of Melasma on the Face
Before embarking on any treatment it’s super important to understand that melasma is a chronic condition. This means it’s not usually curable. Whilst you can get rid of melasma hyperpigmentation on the face or significantly fade it, it can always flareup. As such treatment should focus on keeping under control in the long term just like any chronic condition. Furthermore, many people may require a combination of treatments as everyone’s skin responds differently. As such, you need a very personalised approach. Below are the treatments that can help get rid of melasma on the face:
- Sun Protection: There’s absolutely no point in considering any treatment without this. Daily sun protection is non-negotiable. Without it, even the most advanced treatments will struggle to make a dent. Use a broad-spectrum sunscreen with at least SPF 30 or higher every single day even if you’re indoors or it’s cloudy. If you have sensitive skin, choose physical/mineral sunscreens (with zinc oxide or titanium dioxide) as they’re less irritating. Make sure you reapply sunscreen every 2–3 hours and don’t forget physical barriers like wide-brimmed hats and sunglasses.
- Hydroquinone: This is the gold standard for melasma especially in people with more pigmented skin tones. In the UK, Hydroquinone is a topical prescription only treatment. It inhibits melanin production and is used in strengths of between 4-10% (depending on severity and location) usually with other ingredients like Tretinoin either as stand alone products or compounded formulas. In short-term cycles to avoid irritation, resistance and ochronosis.
- Retinoids: These vitamin A derivatives increase cell turnover and enhance the effectiveness of other brightening agents. They also stimulate collagen production, which can help improve overall skin tone and texture. The most common retinoid for treating melasma is Tretinoin. This is a prescription only treatment that is usually most effective alongside Hydroquinone.
- Azelaic Acid: This multitasking ingredient can help reduce excess melanin and calm inflammation. It is available over the counter in strengths of 10% and below or by prescription for higher concentrations. Azelaic acid is a great option for sensitive skin and in lower strengths can be safely used during pregnancy.
- Hydrocortisone: This mild topical steroid helps calm inflammation and irritation. Hydrocortisone is commonly used in prescription melasma treatments alongside Hydroquinone and Tretinoin (this is called “triple combination therapy”). It mainly helps reduce skin sensitivity caused by these stronger actives and is usually used for short periods at a time.
- Tranexamic Acid: This prescription only medicine was originally used to treat heavy periods, oral tranexamic acid has shown promise in treating stubborn melasma. It works by reducing vascular factors and inflammation linked to melanin production. It is also available without prescription in both over the counter face serums or creams where it is also effective for getting rid of mild to moderate melasma.
- Kojic Acid & Arbutin: These are both available in over the counter skincare such as serums and creams. They works by blocking the enzyme tyrosinase, which plays a key role in melanin production. Whilst both Arbutin and Kojic acid are unlikley to get rid of melasma on the face by themselves but can be useful in complimenting treatments like retinoids or as maintenance after Hydroquinone.
- Niacinamide: This is a versatile skincare ingredient that helps fade hyperpigmentation by slowing down the transfer of melanin to skin cells. Niacinamide also supports the skin barrier, reduces inflammation and improves hydration. It usually works best in combination with other brightening agents like retinoids, azelaic acid or hydroquinone to help get rid of melasma or maintain results.
- Chemical Peels: Mild peels containing lactic, mandelic, glycolic or salicylic acid can help exfoliate pigmented skin to boost the results of mealsma skincare. However, overly aggressive peels can actually worsen melasma especially in people with sensitive or skin of colour.
- Laser: Low-fluence Q-switched lasers and picosecond lasers may help break up pigment clusters. However laser therapy must be used cautiously. In the wrong hands, lasers can trigger rebound hyperpigmentation especially in darker skin tones.
How Long Does it Take to Get Rid of Melasma on the Face?
Melasma won’t vanish overnight. On average people start to see early improvements 2-3 months but more substantial fading can take 6 months or longer. This requires consistent use of the correct treatment(s) which often requires careful titration per your skin’s response. In addition to the above treatments, there are also a number of lifestyle and skincare habits that can help maximise your chances of getting rid of melasma. Below are some top tips and habits that can help support your melasma treatments:
- Avoid heat and sun exposure including saunas or hot yoga.
- Choose fragrance-free and gentle skincare products to avoid inflammation.
- Add antioxidants like vitamin C or glutathione to protect against oxidative stress.
- Avoid over-exfoliation by sticking to once or twice weekly. It is generally best to use mild acids or enzymes rathar than physical exfoliants.
- Be patient! Stick to a consistent routine for at least 8–12 weeks and complete any course of treatment before evaluating results.
- Get professional help from a Dermatologist or other skin professional to help you start the best treatment for your skin.
How to Prevent Melasma from Coming Back
Unfortunately, melasma has a really high relapse rate especially if you don’t manage to adequately protect your skin from sun exposure. Here’s how to maintain your results:
- Continue using sunscreen daily even if your pigmentation has faded.
- use a melasma focused skincare routine with ingredients like tranexamic acid, arbutin, azelaic acid, naicinamide or retinoids to help maintain your results.
- Adjust your skincare routine to accommodate seasonal changes, skin sensitivities or hormonal shifts.
- Seek help early if you notice signs of recurrence so you don’t start from the beginning.
While there’s no one-size-fits-all way to get rid of melasma on the face, there are a few highly effective treatments that work. Its really important however to think of melasma as a chronic skin condition which can flare up. The best approach combines fading hyperpigmentation, maintaining the outcomes and avoiding triggers where possible. You also need a lot of patience and consistency.
At City Skin clinic, we are devoted to personalised skincare. Our virtual skin clinic offers safe and effective custom melasma treatments containing ingredients like Tretinoin, Hydroquinone and Tranexamic acid where appropriate. We also treat other skin conditions like acne, hyperpigmentation and skin ageing. Start a virtual consultation with one of our doctors today. The journey towards great skin starts here.
