Melasma: causes, treatments that work, and how to keep it from coming back
Melasma explained: why it appears, the role of sun, hormones and pregnancy, treatments dermatologists use, how long they take, and daily sun protection.
The short answer
Melasma causes brown patches, often triggered by sun, pregnancy or hormones. Daily broad-spectrum SPF 30+ with iron oxide is the most important step. Treatments include hydroquinone, triple cream, azelaic acid and procedures.
- Results take 3 to 12 months, and maintenance is usually needed.
Melasma is a common skin condition that causes brown or gray-brown patches, usually on the cheeks, forehead, upper lip and chin. It is harmless, but it can be stubborn and it tends to return, especially with sun exposure. The good news is that a consistent routine of sun protection and the right treatment can fade it a lot. Here is what causes melasma, the treatments dermatologists use, how long they take, and how to keep it from coming back.
General information, not medical advice. A dermatologist can confirm melasma and rule out other causes of dark patches.
What causes melasma?
According to the American Academy of Dermatology, pregnancy and certain medicines can trigger melasma, and sunlight, birth control pills and even stress can trigger it too. Sunlight makes the skin produce more pigment, which darkens existing patches and can cause new ones. Melasma is much more common in women, and in people whose skin tans easily.
Does melasma go away?
Sometimes. The AAD says that when a trigger such as pregnancy or a medicine causes melasma, it may fade after the baby is born or once the medicine is stopped. For many people, though, it lasts for years. It cannot harm your body, but many people choose to treat it.
Treatments dermatologists use
| Treatment | What it is | Worth knowing |
|---|---|---|
| Hydroquinone | Prescription cream that lightens pigment | No longer sold over the counter in the US |
| Triple combination cream | Tretinoin, a corticosteroid and hydroquinone | A common prescription first choice |
| Azelaic acid, kojic acid, vitamin C | Gentler topical options | Often used for sensitive skin or maintenance |
| Tranexamic acid | Pill or topical | For hard-to-treat cases; tell your doctor if you have had a blood clot |
| Peels, microneedling, lasers | In-office procedures | Added when creams are not enough; only by a board-certified dermatologist |
Source: American Academy of Dermatology, melasma diagnosis and treatment.
Azelaic acid vs hydroquinone
Hydroquinone is the classic melasma treatment, but it is prescription-only in the US. Azelaic acid is a gentler alternative: a 2023 meta-analysis of six randomized trials found azelaic acid reduced melasma severity slightly more than hydroquinone, with similar side effects. Your dermatologist can help you choose.
How long does melasma treatment take?
The AAD says results usually take 3 to 12 months, and longer if melasma has been there for a long time. Melasma often returns with sun exposure, heat or hormonal changes, so most people need ongoing maintenance.
Sun protection: the most important step
- Broad-spectrum sunscreen, SPF 30 or higher, applied every morning and reapplied through the day, as the AAD recommends.
- Choose zinc oxide, titanium dioxide or iron oxide. The AAD notes tinted sunscreens can help, and iron oxide also blocks visible light.
- A wide-brimmed hat and shade outdoors.
- Every day, all year, including cloudy days and near windows.
Our guide to the best sunscreen for your face covers tinted and mineral options.
Melasma and pregnancy
Melasma during pregnancy is sometimes called "the mask of pregnancy." It often fades after delivery. Many melasma treatments, including hydroquinone and retinoids, are not recommended during pregnancy, so focus on sun protection and ask your doctor before using any treatment.
A simple daily routine for melasma
- Morning: gentle cleanser, an antioxidant such as vitamin C if your skin tolerates it, moisturizer, then a tinted mineral sunscreen.
- Midday: reapply sunscreen, or use a tinted SPF powder or stick over makeup.
- Evening: gentle cleanser, your prescribed treatment or azelaic acid, then moisturizer.
- Weekly: skip scrubs; if you exfoliate, use a gentle product your dermatologist approves.
How to cover melasma
- Apply in order: melasma treatment, then sunscreen, then makeup, as the AAD suggests.
- A peach or orange color corrector neutralizes brown patches on light to medium skin; a deeper orange or red suits darker skin.
- Foundation that matches your skin; see foundation shade matching.
What makes melasma worse
- Sun and heat, including saunas and hot yoga for some people; see infrared sauna benefits.
- Harsh scrubs and irritating products, which can inflame skin and darken patches.
- Waxing on the face, which can irritate skin.
- Stopping treatment too soon.
Gentle routines help; see Korean skin care for a hydrating approach and peptides for skin for gentle actives.
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Questions people ask about this
What causes melasma?
Sunlight, pregnancy, birth control pills, certain medicines and even stress can trigger it, according to the American Academy of Dermatology.
Does melasma go away on its own?
Sometimes, if a trigger such as pregnancy or a medicine caused it. For many people it lasts for years without treatment.
What is the best treatment for melasma?
Dermatologists often use hydroquinone or a triple combination cream, with gentler options like azelaic acid, kojic acid or vitamin C, plus strict daily sun protection.
How long does it take to fade melasma?
Usually 3 to 12 months, and longer if it has been present for a long time.
Which sunscreen is best for melasma?
A broad-spectrum SPF 30 or higher with zinc oxide, titanium dioxide or iron oxide. Tinted sunscreens with iron oxide also block visible light.
Is melasma common in pregnancy?
Yes. It often fades after delivery. Many treatments are not recommended during pregnancy, so focus on sun protection and ask your doctor.
