How do I get rid of melasma discoloration?

Key Points

• Melasma is a skin condition that causes dark spots or discoloration. It’s commonly known as the “mask of pregnancy” because it’s very common in pregnant people.
• There’s no cure for melasma. But sun protection and medications can help minimize symptom severity.
• Not all medications are safe for everyone, especially those who are pregnant or on hormonal birth control pills or patches. Dr. B can connect you with a licensed provider to help you find the best melasma medication for you.

Melasma is the medical term for dark spots or skin discoloration. They may look like grayish-brown, brown, tan, or bluish-gray patches or like large freckles, age spots, or sun spots. Melasma usually occurs on the face and upper lip but can also appear in other areas.

Although the spots are completely harmless, they can significantly affect quality of life and can be difficult to treat.

Melasma treatment is highly individualized. Not every medication is safe—especially if you’re one of the many pregnant people who develop melasma. That’s why it’s important to work with a medical provider to develop the right treatment plan.

Read on to learn which medications can help treat melasma—and which may not be safe.

And if you want expert help finding the right melasma treatment for your skin? Dr. B can connect you with a licensed provider through a convenient $15 online melasma consultation.

What causes melasma?

Your skin is full of melanocytes, special cells that produce melanin. Melanin is responsible for your skin and eye color. While melanin plays an important role in protecting your skin from sun damage, sometimes melanocytes can kick into overdrive and produce extra melanin.

The exact cause of melasma is unknown. But researchers think that hormones like estrogen and progesterone can make melanocytes more sensitive. When sunlight hits melanocytes that are already primed by hormones, these cells can start producing extra melanin.

One of the major triggers for melasma is hormonal changes during pregnancy, which is why this condition is known as the mask of pregnancy. Similarly, hormonal birth control can cause melasma to flare up. Thyroid disease is another culprit. Sun exposure can also trigger melasma.

Genetics also play a role in this condition, so it might not be possible to avoid it completely. But you can minimize the risk by staying out of the sun, using SPF and avoiding hormonal medications when possible.

Does melasma ever go away on its own?

Melasma can sometimes fade or go away, especially if your skin changes are caused by pregnancy or a certain medication. Your skin might improve when you deliver the baby or stop using the medication.

Other people may have skin changes that last for years or even their entire lifetime. But some treatments can help.

Home treatments for melasma

A good skincare plan—including sunscreen—is the basis of any melasma treatment plan. When it comes to skincare, look for products that block UVA/UVB and visible light. Each type of sunlight can trigger melanocytes to make more melanin.

If you’re looking to combine products, look for tinted moisturizers. This type of cosmetic contains an ingredient called iron oxide, which helps block visible light as well as UVA/UVB rays. And wear SPF even indoors. (Visible light can travel through windows.)

Here’s how you can reduce the chances of developing melasma by protecting yourself from the sun:

• Use broad-spectrum SPF 30 or higher, even indoors
• Wear a wide-brimmed hat while outdoors
• Stay in the shade when possible

Some over-the-counter products like Vitamin C and niacinamide might also help. Just talk to your provider before trying them to make sure they’re safe for you.

Medical treatments for melasma

Prescription treatments can help even and lighten skin tone. Except for azelaic acid, most of these products aren’t safe during pregnancy. Others should only be used for a short amount of time. So don’t start any prescription treatments without talking to your provider first.

Some common treatments include:

• Hydroquinone
• Tretinoin
• Azelaic acid
• Vitamin C
• Kojic acid
• Corticosteroids

Many patients benefit from combination therapy, which combines hydroquinone with a retinoid and a steroid. Retinoids increase skin cell turnover, and steroids decrease inflammation.

Another medication, tranexamic acid, can help in severe cases. It works by reducing extra blood vessels in the skin.

Ask your provider if your other medications could be making your melasma worse. Hormonal birth control, hormone replacement therapy and some anti-seizure medications can make melasma worse. But don’t stop any medications without talking to your provider.

If you follow your skincare plan, you should see results in a few months. But your results will depend on how extensive your condition is and how long you’ve had it.

Intensive treatment for melasma

If topical medications don’t work, more invasive treatments can be done in a dermatologist’s office. These include microneedling, chemical peels and laser treatments.

Chemical peels remove the top layer of skin. Laser and light therapy can destroy the cells that make pigment in the skin. These do carry a risk of relapse, though, meaning that the dark spots might come back.

The bottom line?

Unfortunately, there’s no cure for melasma. But with good sun protection and the right treatment, it’s possible to even out skin tone.

If you’re looking for a prescription melasma medication, Dr. B can help!

Start an online consultation to connect with a licensed provider for just $15—less than most doctor copays. We’ll connect you with a licensed provider in your state who will guide you through treatment options to help you find the safest and most effective one for your skin type and health history.

If a prescription is appropriate, they’ll send it to the pharmacy of your choice. And there’s no appointment or video chat required.

Sources

Basit H, et al. (2023). Melasma. StatPearls Publishing.

Garibyan, L., et al. (2022). Melasma: What are the best treatments? Harvard Health.

Hollinger J.C., et al. (2018). Are natural ingredients effective in the management of hyperpigmentation? A systematic review. Journal of Clinical Aesthetic Dermatology.

National Cancer Institute. Melanocyte.

Rajanala, S, et al. (2019). Melasma pathogenesis: a review of the latest research, pathological findings, and investigational therapies. *Dermatology Online Journa*l.

Yalamanchili, R, et al. (2015). Clinico-epidemiological study and quality of life assessment in melasma. Indian Journal of Dermatology.