Melasma

Melasma is a common, harmless skin condition. It shows up as patches of brown or grey-brown pigment on the face and neck. The cheeks, forehead and upper lip are the usual sites. Melasma occurs when the skin makes too much melanin, the pigment that gives skin its colour. Usually a mix of sun and hormones triggers it and it is far more common in women and in deeper skin tones. Melasma is also one of the most stubborn types of hyperpigmentation to treat and frequently relapses. So the aim of treatment is to fade it and keep it under control. In this guide we explain what melasma is, what causes it and who gets it. We also cover the best melasma treatments from everyday skincare through to professional treatments.

City Skin Clinic is an online skincare clinic. We provide and prescribe medical skincare and do not offer in-clinic procedures such as chemical peels, laser treatment or energy-based devices. However, we have explained all the options below because we believe the public deserve clear, evidence-led information without commercial bias.

What is Melasma?

Melasma is a type of hyperpigmentation where patches of skin turn darker than the surrounding area. The patches are usually larger and symmetrical, with matching marks on both sides of the face. The cheeks, forehead, upper lip and bridge of the nose are the most common sites. It can also affect the neck and forearms, and more rarely the back and chest. Melasma itself does not itch, hurt or feel rough, so the patches are usually its only sign. The pigment sits at different depths in the skin. Epidermal melasma sits near the surface and responds better to treatment. Dermal melasma sits deeper and is more stubborn. Mixed melasma is a combination of the two and most common. This is important to understand as depth partly determines how well it responds to treatments and why melasma can be slow to clear.

What Causes Melasma?

The exact cause of melasma is not fully understood. We do know it develops when the skin’s pigment cells (melanocytes) become overactive and make too much melanin. Several triggers set this off, and understanding them is the key to treating melasma and preventing flare-ups. The main melasma triggers are:

• Sun & visible light: UV exposure is the single biggest trigger. This is why melasma worsens in summer and improves in winter. Visible light, including blue light from screens, and heat can also trigger or make melasma worse.
• Hormones: Melasma has a strong link to hormonal change. It is so common in pregnancy that people call it the mask of pregnancy. Menopause, the contraceptive pill and HRT can trigger it too, as oestrogen and progesterone stimulate the pigment cells.
• Genetics: Melasma often runs in families. People with a family history are more likely to develop it, as are those with deeper skin tones.
• Skin irritation: Harsh products, over-exfoliation and aggressive peels or lasers can provoke melasma in people prone to it. This is why a gentle approach matters.

Who Gets Melasma?

Melasma can affect anyone, but some groups are far more prone to it. Below are the most common risk factors for melasma:

• Women: Melasma is much more common in women than men, who account for the large majority of cases. The strong link to hormones explains much of this.
• Deeper skin tones: Melasma is more common in skin of colour, especially people from Hispanic, Asian, Mediterranean and African backgrounds, where melanocytes are more active. The patches can look darker and more noticeable. Skin of colour is also more prone to post-inflammatory hyperpigmentation, which looks similar to melasma and can exaggerate it.
• Men: Around 1 in 10 cases of melasma occur in men. It looks the same in men and stems mainly from sun and genetics rather than hormones. It is more common in men with deeper skin tones.
• Pregnancy & menopause: Melasma affects up to 50% of pregnant women, who know it as chloasma. It can also appear during menopause or with HRT as hormone levels shift.

Is Melasma Diagnosable?

A doctor usually diagnoses melasma by examining the skin, since the symmetrical pattern and typical sites are quite distinctive. They may also use a Wood’s light, a special ultraviolet lamp, to see how deep the pigment sits and guide treatment. Epidermal pigment stands out more clearly under the lamp than deeper dermal pigment. Very occasionally a doctor takes a small skin sample (a biopsy) to rule out other conditions. If a patch is one-sided, changing quickly or looks unusual, see a doctor to rule out anything more serious first.

How is Melasma Treated?

Melasma is usually treatable but stubborn. Because it is chronic, the goal is to fade it and keep it under control rather than cure it. Sun protection is the foundation of every approach, since without it no treatment can hold. The most commonly used melasma treatments are:

• Prescription topicals: Hydroquinone is the gold standard and slows melanin production. It often pairs with tretinoin and a mild steroid as triple combination therapy, the most effective approach for stubborn melasma.
• Other topical actives: Azelaic acid, niacinamide, arbutin, kojic acid, cysteamine and topical tranexamic acid all help fade pigment and work well for maintenance. They are gentler than hydroquinone, which makes them useful for sensitive skin or during hydroquinone breaks.
• Oral medication: For stubborn melasma that has not responded to creams, a doctor may prescribe oral tranexamic acid. This tablet, originally used for heavy periods, targets the blood vessels and inflammation linked to melasma. It is used in a low dose for a limited time and is not suitable for everyone.
• Sunscreen: A daily broad-spectrum sunscreen with at least SPF 30, ideally higher, is non-negotiable. UV and visible light drive melasma, so this is the one step you cannot skip.

Dermatologists sometimes use professional treatments like chemical peels and laser. However, these need great caution. Used too aggressively, they can worsen melasma and trigger rebound hyperpigmentation, especially in deeper skin tones. So topical treatment is almost always the safer first step. Our guide to getting rid of melasma covers the actives, strengths and combinations in detail including prescription melasma treatments.

Is Melasma Permanent?

Melasma is not usually permanent, but it is chronic, so it can fade with treatment and then flare again. Pregnancy-related melasma often improves on its own once hormones settle after birth. Stopping a hormonal trigger like the pill can help too. For many people, though, melasma is a long-term condition that needs ongoing management. With consistent treatment, most people see early improvement within 3 months. However, more meaningful fading takes 6 months or longer.

Recurrence is the rule rather than the exception. Melasma commonly returns once treatment stops, sun protection slips or hormones shift. The encouraging part is that maintenance works. Research shows that staying on a maintenance routine kept over half of patients relapse-free at 6 months. So daily sunscreen and an ongoing melasma skincare routine are essential for maintaining the results even after the pigment has faded.

Can You Prevent Melasma?

You cannot generally prevent melasma as it has genetic and hormonal drivers. You can, however, reduce flare-ups and fade existing patches. Sun protection matters most, since UV and visible light are the main triggers. Research shows daily sunscreen prevents measurable sun damage. Guidelines recommend a broad-spectrum sunscreen of at least SPF 30 for melasma though higher is better. Ideally it should contain iron oxides, which screen visible light too. Avoiding heat, choosing gentle fragrance-free skincare and reviewing hormonal triggers and medicines with your doctor all help.

At City Skin Clinic, our doctors create personalised topical skincare treatments to fade melasma. Where appropriate, we use actives like tretinoin, hydroquinone and tranexamic acid. Every plan starts with an online consultation built around your skin and your goals. Start your online consultation today. The journey towards great skin starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.