Melasma is a common skin condition that causes dark spots and patches on the skin, most often on the face. It occurs much more often in women than in men.¹ 

With the condition melasma, exposure to sunlight causes skin to produce more melanin pigments, causing dark spots. Pregnancy or hormonal birth control is the most common cause of melasma in women. Other causes of melasma include:^2,3

• Genetics

• Hormones, particularly during pregnancy

• Use of oral contraceptives

• Thyroid disease

The most common places for melasma to appear are on the cheeks, chin, nose bridge, forehead and above the upper lip.⁴ For some people, darker pigmentation can occur on the upper lip and resembles a mustache.⁵

Melasma is not physically harmful. Even though melasma reacts to sun exposure, there is no evidence to suggest that the condition increases risk of skin cancer.⁶

However, some people with melasma can experience psychological issues or a poorer quality of life because of perceptions of their appearance.⁷

Melasma commonly appears on the face. Less commonly it can appear on the arms, neck or other parts of the body.⁸

Hyperpigmentation refers to any discoloration of the skin, regardless of the cause. Melasma is a specific type or cause of hyperpigmentation.⁹

Sunspots, also known as age spots, dark spots or liver spots, are small areas of hyperpigmentation on the skin caused by ultraviolet light (UV) exposure to the skin.¹⁰ Melasma can be triggered by sun; however, the underlying cause can be hormonal or genetic.¹¹

Sunspots occur most often in people over age 50 but can occur in younger people.¹² Melasma occurs most commonly in women in their reproductive years.¹³

For more information, read our complete guide on the differences between melasma, hyperpigmentation and sunspots.

Yes, melasma commonly occurs during pregnancy, likely due to hormonal changes.¹⁴ 

Melasma is a photosensitive condition that is exacerbated by exposure to the sun. Therefore, regular use of UV + VL broad-spectrum sunscreen can be used as a preventive treatment for melasma.¹⁵ 

There is currently no cure for melasma. However, dark spots can be reduced or prevented by limiting sun exposure. Also, hyperpigmentation can be lightened or reversed by using topical or oral medications.¹⁶ 

It’s possible that your melasma will go away on its own, particularly if the cause is pregnancy or a medication you’re taking temporarily. However, it is not likely to go away while you’re pregnant or taking certain medications such as hormone contraceptives.¹⁷ 

¹ American Academy of Dermatology

² National Library of Medicine

³ National Library of Medicine

⁴ American Academy of Dermatology

⁵ Cleveland Clinic

⁶ American Academy of Dermatology

⁷ Harvard Health

⁸ American Academy of Dermatology

⁹ Allure

¹⁰ Mayo Clinic

¹¹ National Library of Medicine

¹² Mayo Clinic

¹³ National Library of Medicine

¹⁴ National Library of Medicine

¹⁵ National Library of Medicine

¹⁶ Harvard Health

¹⁷ Cleveland Clinic

There are a variety of treatments available for melasma and dark spots. Some treatments will help prevent dark spots from forming and others will help lighten dark spots that have already formed. Here is an overview of some of the types of melasma treatments.

Sunscreen

Limiting sun exposure and using sunscreen is one of the best treatments for melasma. Studies show that broad-spectrum tinted sunscreens with iron oxide are effective at lowering pigment production in the skin in melasma patients because they block visible light and UVA/UVB rays.¹⁸

Topical Skin Treatments

Dark spots caused by melasma can be lightened using topical skin-lightening medications, including creams, lotions and gels that may include hydroquinone, azelaic acid, tretinoin, tazarotene or adapalene. These medications reduce the amount of melanin in the skin where they are applied.¹⁹

Chemical Peels

If limiting sun exposure and topical treatments fail, melasma can be treated with chemical skin peels. Using glycolic or salicylic acid-based compounds, a chemical skin peel can help increase skin cell turnover. The results of a chemical peel can be unpredictable and sometimes result in adverse effects like scarring or increased hyperpigmentation.²⁰

Lasers

Laser treatment can destroy the pigment in skin to lighten melasma spots. However, the risk is considerable for relapse post-treatment.²¹

Topical prescription medications that have clinical support for treating melasma and dark spots include:

• Tretinoin Cream (Generic Retin-A®)²²

• Tazarotene 0.1% Cream (Generic Tazorac®)²³

• Adapalene Gel (Generic Differin®)²⁴

• Azelaic Acid 15% Gel (Generic Finacea®)²⁵

• Hydroquinone cream, treats blemishes and dark spots²⁶
  

Topical treatments for melasma must be continued for several months before noticeable changes may occur.²⁷ In some studies, uses of topical treatments for hyperpigmentation saw noticeable results within eight to 12 weeks.²⁸ Another study showed significant results after 40 weeks of daily tretinoin use, so it can vary on the individual and treatment.²⁹

Most over-the-counter melasma treatments are considered cosmetics and are not required to have FDA approval.³⁵ There is currently a lack of research to prove nonprescription effectiveness in treating hyperpigmentation from melasma.³⁶

Telehealth providers, like RedBox Rx, allow you to connect with a licensed provider of dermatological services anywhere you have an internet connection. If prescribed, we can ship prescription treatment for melasma to all 50 U.S. states. Start an online consult now.

¹⁸ Harvard Health

¹⁹ WebMD

²⁰ National Library of Medicine

²¹ Harvard Health

²² National Library of Medicine

²³ National Library of Medicine

²⁴ National Library of Medicine

²⁵ National Library of Medicine

²⁶ National Library of Medicine

²⁷ National Library of Medicine

²⁸ National Library of Medicine

²⁹ National Library of Medicine

³⁰ U.S. Food and Drug Administration

³¹ National Library of Medicine

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