Melasma is a pigment condition that causes brown or gray-brown patches, usually across the cheeks, forehead and upper lip. It is driven by light, heat and hormones, which is why it is managed rather than cured. Small flat pigment marks, also called ephelides, that often darken with sun exposure.
The same eight facts on every condition comparison.
Centrofacial melasma Forehead, cheeks, nose and lip; most common.
Malar melasma Cheeks and nose.
Mandibular melasma Along the jawline.
Freckles Freckles are scattered densely across the nose and both cheeks.
Pigment cells become more active and supply extra melanin to patches of skin. Light, hormones and individual susceptibility contribute, and some pigment may also be present deeper in the skin.
Inherited sensitivity to ultraviolet light increases melanin production in small areas. The extra pigment darkens the spots with sun exposure rather than creating a raised growth.
Melasma. Usually appears in adult life and may begin during pregnancy or with hormonal changes.
Freckles. Usually first appears in childhood rather than at birth.
Melasma happens when pigment cells become overactive in response to light and hormones. Visible light and heat also play a part, not just ultraviolet light.
Inherited pigment response causes local melanin production with ultraviolet exposure.
About half of people with melasma have a family member with it.
Evidence labels come from each condition’s own treatment list.
Freckles do not require treatment. Sun protection helps reduce darkening; have an uncertain or changing spot checked before considering cosmetic pigment treatment.
Calms overactive pigment cells without bleaching the normal skin around them, which is why it can be used for months at a time instead of in short courses. That makes it one of the better options for holding a result after a course of hydroquinone. The over-the-counter strength works slowly, and the prescription strength works better.
Put on dry skin, left for about 15 minutes and then washed off rather than left on overnight. It is the over-the-counter option with the most real trial evidence in melasma, and it suits people who want to avoid hydroquinone or need something for the gaps between courses. The smell is the usual reason people give up on it.
Works on a different part of melasma from the pigment-blocking creams. It quietens the signals coming from blood vessels and the skin underneath, which is the fourth step and the reason patches keep returning. That makes it a useful addition for stubborn melasma rather than a first treatment on its own. Twice a day, judged at three months.
Slows the handover of pigment from pigment cells to the skin cells around them. Modest on its own and not something that will clear a patch, but it is well tolerated and it does not sting, which counts for a lot in a condition where irritation makes things worse. It sits comfortably alongside the stronger treatments.
Lightens surface pigment a little and helps sunscreen do its job during the day. It is a reasonable thing to try in the three months before asking for a prescription, and a reasonable thing to keep for maintenance afterwards. On its own it rarely shifts an established patch, and it does not replace sun protection.
A gentler relative of hydroquinone that releases a small amount of it slowly in the skin. It suits people who want a lightening step running between supervised courses of the prescription version. The effect is milder and slower, and the studies behind it in melasma are small.
Blocks the same pigment-making enzyme hydroquinone does, more weakly. It is nearly always sold combined with other lightening ingredients, and the studies showing it work are studies of those combinations rather than of kojic acid alone. It stings some people, and stinging on a melasma patch tends to darken it.
A common ingredient in brightening products, resting mainly on laboratory work rather than trials in people with melasma. It is gentle and unlikely to cause trouble, and it is also unlikely to be the thing that clears a patch. If a routine only has room for one active, this is not the one to pick.
Hydroquinone, a retinoid and a mild steroid in one cream, used at night on the patches. It is the most effective topical treatment for melasma and the one with the best trial evidence, given as a course of a few months rather than indefinitely. It is also the one that most needs a doctor watching it, because the steroid thins skin with long use and the hydroquinone is meant to be stopped and restarted.
The most established single prescription cream for melasma, applied thinly at night to the patches only. It is used in courses of about three to four months with breaks in between, not continuously for years — unbroken long-term use at high strength is what causes the blue-black discoloration people have heard about. Expect the first month to look like nothing is happening.
Speeds up how quickly pigmented skin cells are shed, and helps the other creams get in, which is why it is more often part of a combination than used alone. Used by itself it works slowly and it can irritate, and irritation darkens melasma, so it is started at a low strength a few nights a week. Ask your doctor about it if you are pregnant or trying to become pregnant.
A low-dose tablet, usually taken for a few months, for melasma that has not answered creams and daily sun protection. It works on the blood vessel and signalling side of the condition rather than by bleaching, and the trials behind it are reasonable. It is not for everyone: a history of blood clots or certain other risks rules it out, so it comes after a proper history. Melasma usually returns once it is stopped, so sun protection carries on.
The combined pill, the patch, the implant and menopausal hormone therapy can all set melasma off or keep it dark. Stopping sometimes helps and sometimes does not, and it can take many months to show. Never stop a prescribed hormone on your own. Ask the prescriber whether a different method makes sense, and weigh that against what the contraception is doing for you.
Light peels, spaced out, speed up the clearing of surface pigment when they are added to creams and sun protection. They are an addition and never a replacement. Depth is the whole issue: a peel strong enough to leave the skin red and peeling can inflame it and leave the patch darker than it started, which is one of the commonest ways melasma gets worse.
Used at low energy over several sessions to break up pigment that creams reach poorly. It can lighten stubborn patches, and the improvement often fades over the following months if creams and daily sun protection are not carrying on behind it. Pushed too hard it causes patchy loss of color or rebound darkening, so settings stay low and a test patch first is sensible.
A newer laser that delivers very short pulses at low energy, aimed at the deeper pigment creams struggle with. The melasma studies so far are small and cautiously encouraging. Like every device used here it is an addition to creams and sun protection rather than a shortcut past them, and results still fade without them.
Fine needles make temporary channels that help tranexamic acid or other treatments reach deeper, and that combination is where the evidence sits — not needling on its own. It has to be done gently. Aggressive needling inflames the skin, and inflamed skin with active pigment cells makes more pigment, not less.
IPL. Often offered for facial pigment, and often the wrong choice for melasma. It can lighten patches briefly and then bring them back darker within weeks, because the heat it delivers is itself a trigger for pigment cells. It works far better on sun spots, which is part of why telling the two apart matters before booking anything.
An ablative resurfacing laser with a real risk of making melasma worse, particularly on medium and deep skin tones. Any benefit tends to be short-lived and the rebound darkening can last a long time. If a clinic is offering aggressive resurfacing as the answer to melasma, that is a reason to get a second opinion.
Melasma follows the seasons. Patches darken through spring and summer and lighten through autumn and winter. A good winter can look like a cure, which is exactly when people stop their sunscreen and lose the ground they gained.
Freckles often darken with sun exposure and become less visible when exposure decreases. They are harmless, but a new or changing pigmented spot should not automatically be assumed to be a freckle.
Post-Inflammatory Hyperpigmentation
Melasma is the condition where pushing hard backfires most often. A strong peel, a high-energy laser or an irritating cream can inflame the skin and leave it more pigmented than it began, and that extra pigment can take many months to settle. It is the reason melasma is treated gently and slowly, and the reason a test patch is worth doing before any device is used across the whole face.
Ochronosis from lightening creams
Long, unbroken use of high-strength hydroquinone, usually from creams bought outside a doctor's care, can leave a blue-black speckled discoloration in the treated area. It is uncommon, and it is much harder to treat than the melasma was. It is avoided by using hydroquinone in supervised courses with breaks rather than continuously for years. Creams sold for lightening outside medical care may also contain strong steroids or mercury, which bring problems of their own.
Living with it day to day
Melasma does not hurt and is not dangerous, which is exactly why its effect gets underestimated. People describe avoiding photographs, spending time and money on makeup that only half covers it, and feeling worse every summer as it darkens. It is a reasonable thing to ask for treatment for, and saying it out loud in the appointment usually changes what gets offered.
A secure diagnosis matters because other lesions can look similar.
Seek assessment for an uncertain pigment change or before stronger fading treatments. Review pregnancy safety and avoid unsupervised bleaching products.
Have a new, growing, bleeding, painful or otherwise changing lesion examined.
For some people yes, especially when pregnancy set it off. For most, it can be made much lighter and kept there, but the tendency stays. Aim for faded and even, then hold it with maintenance.
Give it 12 weeks. Pigment clears slowly and the first weeks look like nothing. If nothing has changed by three months on a daily prescription treatment with proper sun protection, change the plan.
Near a window, yes. Glass blocks most burning ultraviolet but lets through the longer wavelengths and all visible light, and both drive melasma. A tinted sunscreen at a desk by a window is not wasted.
Some treatments are used in pregnancy and others avoided, and that decision belongs to the doctor managing your pregnancy. Sun protection, shade and a gentle routine are reasonable for everyone. Many people wait, since pregnancy melasma often fades in the year after delivery.
No. Pushing hard with lasers is what makes melasma worse. Devices are used cautiously, at low settings, added to creams and sun protection. Anyone promising one-session clearance is describing a different condition.
The pigment cells stay primed and the skin underneath keeps signaling them. A strong summer, a new pregnancy, a hormone change or a few months without sunscreen is enough. Relapse is expected, which is why maintenance is part of the plan.
Small flat pigment marks, also called ephelides, that often darken with sun exposure.
Avoid picking or home removal. Protect exposed skin from the sun.
Have a new, growing, bleeding, painful or otherwise changing lesion examined.
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