Everything You Need to Know About Treating Your Melasma

What is melasma?

Melasma is a very common chronic condition, says dermatologist Y. Claire Chang, MD, of Union Square Laser Dermatology in New York City. “It results in irregular facial pigmentation and brown spots that are present in multiple different patterns, the most common of which is in the center of the face,” she says. “This affects the forehead, cheeks, nose, and upper lip.”

Women between the ages of 20 and 40 are the most susceptible to the condition, especially if it runs in the family. “Other known triggers include sun exposure and hormonal triggers, including pregnancy and birth control pills,” says Dr. Chang. Sometimes, though, the condition appears for no apparent reason, and people who are prone to it tend to notice symptoms worsen in the summer due to UV exposure.

How can you treat melasma?

Unfortunately, melasma can be complex to treat, and as of now there’s no absolute cure. But a dermatologist can help you keep problem areas at bay and prevent the condition from getting worse. Below, we go over a few of the most common melasma treatments and treatment options.  

1. Topical treatments

According to Dr. Chang, there are three categories of topicals that can help improve melasma: lightening agents like hydroquinone, azelaic acid, and kojic acid; skin lightening antioxidants like vitamin C and niacinamide; and ingredients that help speed up skin cell turnover, like topical retinoids and glycolic acid. (This is why glycolic acid-based chemical peels can be especially helpful if you have melasma.) MURAD Rapid Age Spot and Pigment Lightening Serum contains a blend of ingredients from each category, including two percent hydroquinone—the highest potency available over-the-counter—vitamin C, and glycolic acid.

If you find that over-the-counter options aren’t effective, your dermatologist can prescribe you a stronger topical alternative. Dr. Chang recommends Tri-Luma, which is used for eight weeks and combines hydroquinone, a retinoid, and corticosteroid, a topical steroid that reduces inflammation.

2. In-office treatments

“Topical treatments can help fade melasma, but there is often a deeper dermal component that can be more difficult to treat,” says Dr. Chang. This is where lasers come in. The Clear and Brilliant laser, a dermatologist favorite for treating melasma, works by creating millions of microscopic treatment zones in the top layers of the skin—ultimately fading hyperpigmentation and allowing topical treatments to penetrate deeper and more effectively. Picosecond lasers, used for tattoo removal, have also shown potential for melasma treatment, but Dr. Chang notes that larger studies are still being conducted. “Regardless, it’s important to go to a board-certified dermatologist for laser treatment, because some lasers can worsen melasma,” she says.

Your doctor may also recommend a new oral medication called tranexamic acid, which works internally to reverse skin pigmentation. “It should be used in low doses and avoided by patients who are at risk of blood clots, however,” says Dr. Chang.

How can you prevent melasma?

Because there’s no cure for melasma (yet!), it’s important to remember that it can always come back post-treatment, especially if you’re still experiencing hormonal changes or unprotected sun exposure. The easiest and most controllable way to halt a recurrence is—no shocker here—consistently wearing sun protection like sunscreen. “It’s important to wear it every day, even in the wintertime, and to reapply every two to three hours,” says Dr. Chang.

Though many of the most effective melasma treatments are recommended for short-term use, a maintenance regimen involving hydroquinone, antioxidants, and/or retinoids or glycolic acid could also help prevent pigmentation from recurring—so discuss with your doctor which ingredients will be most effective for you.

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