Condition

Melasma

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Melasma. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

Melasma fades with steady treatment and darkens again when the sun comes back. That is the condition behaving normally, not the treatment failing. A prescription cream with no sun protection under it loses ground every summer, so shade, a hat and a tinted sunscreen every day — cloudy days and days at a desk by a window included — are what make the cream worth using. Most of the people I see did nothing to bring this on; pregnancy, hormonal birth control, heat, and skin that pigments readily are the usual reasons.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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How commonOne of the most common pigment conditions dermatologists treat, and one of the most common reasons people ask about uneven skin
Who gets itMostly women between their twenties and forties, and far more often in people with medium to deep skin tones. Men get it too, but much less often
Curable or managedManaged - it fades with treatment and tends to return, particularly in summer and during pregnancy
Prescription neededOften. Sun protection and some over-the-counter ingredients help, but most people need a prescription cream to make real progress
Time to improveAbout 12 weeks to judge a treatment, and longer than that for the patches to look even

What It Is

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Melasma is a patchy darkening of the skin, usually on the face. The patches are flat, so there is nothing to feel, and they do not itch, sting, flake or bleed. Color runs from light tan to deep gray-brown, with irregular but fairly defined edges.

The pattern gives it away. Melasma is close to symmetric: both cheeks, both sides of the forehead, or across the upper lip like a shadow of a mustache. Dermatologists group it by where it sits — the middle of the face, over the cheekbones, or along the jawline. It also appears on the forearms, the neck and the upper chest, where the sun reaches.

It is not dangerous, not contagious, not a sign of cancer, and it does not turn into anything else. The problem is cosmetic, and a large one, since it sits on the face and concealer does not cover it reliably.

Depth matters. Pigment in the top layer is reachable by creams; pigment deeper down is not, and lasers reach it unpredictably. Most people have both, which is why a patch can look half-treated after a good course rather than gone.

Symptoms

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Forehead
Patches on forehead, nose and chin

Forehead

Symmetrical brown or gray-brown patches across the forehead, nose, upper lip and chin, with soft, blurred edges. It darkens with sun, heat and hormonal change. Daily sun protection does more for it than any single product.
Cheeks
Patches over the cheeks

Cheeks

Patches sitting mainly over the cheekbones on both sides, often in a mirror-image pattern. It is common in pregnancy and with hormonal contraception. It can fade slowly after the hormonal trigger changes, but not always.
Upper Lip
Patches along the jaw

Upper Lip

Patches along the jawline and sides of the face, which tend to appear later in life. This pattern is often more stubborn than the others. Heat and visible light, not only ultraviolet, keep it going.

How It Looks by Skin Tone

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Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.Flat mid-brown patches with soft irregular edges across the forehead and upper cheek of an adult with medium tan skin, the surface completely smooth.Flat gray-brown patches with soft irregular edges across the forehead and upper cheek of an adult with brown skin, the surface completely smooth.Flat slate gray-brown patches with soft irregular edges across the forehead and upper cheek of an adult with deep brown skin, the surface completely smooth.
LightMediumBrownDeep

Melasma is much more common in medium and deep skin tones — most often in people of East Asian, South Asian, Hispanic and Latino, Middle Eastern, North African and Black heritage — and it arrives earlier and covers more of the face. More active pigment cells mean a stronger response to the same sunlight, heat or hormone change.

Visible light is the part that gets missed. On lighter skin tones ultraviolet does most of the damage and an ordinary sunscreen handles it. On medium and deep skin tones the light you can see also drives pigment, and a clear sunscreen barely touches it. That is why dermatologists push tinted mineral sunscreens — the iron oxides in them block visible light, and the tint is the active part of the plan, not a cosmetic preference. Depth decides how long treatment takes. Pigment in the deeper layer looks gray, slate or blue-brown and is far more stubborn than pigment near the surface. Deeper skin tones carry more of it, so progress is slower and the realistic goal is lighter and more even rather than gone. The biggest avoidable risk is the treatment itself. Strong peels, high-energy lasers, hair removal lasers near a patch and hard exfoliation all inflame the skin, and inflamed skin with active pigment cells makes more pigment. That is how treatment leaves a face darker than it started. Go in order — sun protection, then prescription creams, then any device treatment at low settings after a test patch, by someone who treats deeper skin tones regularly. Skin lightening creams sold outside a doctor's care often contain high-strength hydroquinone, steroids or mercury. Long, unbroken use of high-strength hydroquinone can cause a blue-black discoloration far harder to treat than the melasma, and strong steroids thin facial skin. Supervised hydroquinone, used in courses, is among the most effective treatments there is. The problem is unsupervised use, not the ingredient.

Where It Shows Up

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Front view of a face with soft brown patches over both cheekbones, reaching out toward both temples. The forehead and lips are clear.
Cheeks
The most common pattern. The patches sit on the cheekbones and spread out toward the temples, and they are close to symmetric — a patch on one cheek almost always has a match on the other.
Front view of a face with soft brown patches across both sides of the forehead and above the brows. The rest of the face is clear.
Forehead
A band across the forehead, strongest at the sides and fading up into the hairline. It is easy to mistake for a tan, because it follows the part of the face the sun reaches first.
Front view of a face with a soft brown band across the skin above the upper lip. The rest of the face is clear.
Upper lip
A brown band above the lip, shaped like a moustache. This is the one people recognize least, and the one most often blamed on waxing or other hair removal.
Front view of a whole body with red marks on both forearms, on the front of the neck and across the upper chest.
Forearms, neck and upper chest
It can also appear on the forearms, the front of the neck and the upper chest, which are the other places the sun reaches every day. These patches respond more slowly than the ones on the face.

What Happens in the Skin

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This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Melasma happens
Skin basics
BARRIEREPIDERMISDERMISPIGMENT CELLMELANOCYTES0NORMAL SKIN1LIGHT AND HEAT REACH THE SKIN2PIGMENT CELLS SWITCH ON3EXTRA PIGMENT IS MADE AND DEPOSITED4THE SKIN UNDERNEATH KEEPS SIGNALLING

Pigment cells sit spaced out along the base of the top layer of skin, handing an even amount of pigment to the cells around them. Sunlight and heat reach normal skin too. These cells switch on briefly, then settle back down, so the color across a cheek stays even.

Sunlight, the visible light we can see, and plain heat all land on the skin. This is why a patch darkens on a cloudy day, over a hot stove or through a car window, and it is the step that sun protection is aimed at.

The pigment cells inside a melasma patch are unusually easy to switch on and slow to switch off, and hormones from pregnancy or the pill keep them primed. That is why the same short walk to the car darkens the patch and does nothing to the skin beside it.

The switched-on cells make extra melanin and hand it to the skin cells around them. Some of it drops through into the deeper layer of skin, where scavenger cells hold onto it, and that deeper pigment is the gray-brown part creams reach poorly.

The skin under a patch is not normal skin. Sun damage, extra blood vessels and the supporting layer beneath keep sending growth signals up to the pigment cells, so they stay primed even when the surface looks even. Almost everything on the lists below is pushing on this step.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Melasma happens in four steps, and each is a place treatment can push on. First, a trigger reaches the skin: sunlight mainly, but also visible light, heat and hormone shifts such as pregnancy or the combined pill. Second, the pigment cells in those patches switch on — in melasma they switch on easily and switch off slowly, which is why the walk to the car that does nothing to nearby skin darkens the patch. Third, those cells make extra melanin and hand it to surrounding skin cells, and some drops into the deeper layer, where scavenger cells hold it for a long time.

The fourth step explains the relapses. The skin under a patch carries sun damage, extra blood vessels and a supporting layer that keeps sending growth signals to the pigment cells. Remove the trigger and that signaling continues, so the cells stay primed and restart when the sun is strong. Treatment that clears only surface pigment leaves the machinery intact, which is why a course of cream can work beautifully and the patch return within a season.

Risk Factors

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Most of what makes someone prone to melasma was never a choice. Skin tone, hormones and family history do most of the work, and they explain why it usually needs long-term management rather than one course of treatment.

Inherited
Skin tone
Much more common in medium and deep skin tones, where pigment cells respond more strongly to light and heat.
Inherited
Family history
Many people with melasma have a close relative with it.
Hormones
Being female
Most cases are in women, and hormones are the reason. Men get melasma too and are often under-diagnosed.
Hormones
Pregnancy
Common enough to have its own name, the mask of pregnancy. It usually starts in the second half.
Hormones
Hormonal contraception and hormone therapy
The combined pill, the patch, implants and menopausal hormone therapy can all set it off or darken it.
Sun & heat
Sun exposure
Not a cause on its own, but the trigger nearly every case depends on. Outdoor work, sunny climates and past tanning raise the risk.
Sun & heat
Heat
Cooking, hot cars, saunas and hot climates keep pigment cells activated without much direct sun.
Other health conditions
Thyroid disease
Thyroid problems turn up more often in people with melasma than chance predicts. The link is real and unexplained.
Other health conditions
Certain medicines
Some make skin more sensitive to light, which can trigger or worsen melasma. Never stop one on your own - ask your doctor.

Course

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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.

First appearanceTwenties to forties
Most cases start in adulthood

Melasma rarely starts in childhood. A first appearance after menopause deserves a second look, to be sure it is melasma.

After the trigger endsMonths to a year
Hormone-driven melasma may fade

Pregnancy melasma often fades in the months after delivery, and many people are close to clear within a year. It does not always clear completely, and it usually returns in a later pregnancy. Melasma from the pill or hormone therapy may improve after stopping, but that takes many months, and stopping is a decision for the doctor who prescribed it.

Left aloneYears
It tends to persist

Untreated melasma stays for years rather than clearing.

TreatedA few months
Most people get real improvement

Improvement builds over a few months rather than arriving at once.

Long termOngoing
Maintenance is what holds the result

Relapse is expected behavior, not a sign something went wrong. Many people find melasma settles as hormone levels change with age, though sun protection still matters.

What Makes It Better & Worse

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Melasma is four problems — light and heat reaching the skin, pigment cells switching on, extra pigment deposited, and damaged skin keeping the signal running. It is easy to make worse, so keep to a gentle routine that treats all four steps.

What is driving yours?

FATPIGMENT CELLMELANOCYTESBARRIEREPIDERMISDERMIS

Sunlight, the visible light we can see, and plain heat all land on the skin. This is why a patch darkens on a cloudy day, over a hot stove or through a car window, and it is the step that sun protection is aimed at.

The pigment cells inside a melasma patch are unusually easy to switch on and slow to switch off, and hormones from pregnancy or the pill keep them primed. That is why the same short walk to the car darkens the patch and does nothing to the skin beside it.

The switched-on cells make extra melanin and hand it to the skin cells around them. Some of it drops through into the deeper layer of skin, where scavenger cells hold onto it, and that deeper pigment is the gray-brown part creams reach poorly.

The skin under a patch is not normal skin. Sun damage, extra blood vessels and the supporting layer beneath keep sending growth signals up to the pigment cells, so they stay primed even when the surface looks even. Almost everything on the lists below is pushing on this step.

What helps

  • A tinted mineral sunscreen every day Broad spectrum, SPF 30 or higher, with iron oxides.
  • Shade, a wide-brimmed hat and sunglasses Does what no sunscreen can.

What makes it worse

  • Sun on unprotected skin The largest driver, and it adds up all season.
  • Visible light Ordinary daylight drives melasma on deeper skin tones.
  • Heat Stoves, saunas, hot yoga, steam and hot cars activate pigment cells.
  • Tanning beds All of the light, none of the upside.
  • Medicines that increase sun sensitivity Ask your prescriber rather than stopping anything.

What helps

  • Hydroquinone The most established prescription treatment, used in courses.
  • Triple combination cream The most effective topical, and the one needing a doctor's supervision.
  • Azelaic acid Calms pigment cells; fine long-term.
  • Cysteamine Over the counter, a short contact treatment.
  • Keep the whole routine gentle Cleanser, moisturizer, treatment, tinted sunscreen.
  • A conversation about hormonal triggers Ask whether an alternative makes sense.

What makes it worse

  • Pregnancy and hormonal contraception Shift the hormones that prime pigment cells — never stop one on your own.
  • Harsh scrubs, peels and lasers Anything that leaves skin red or peeling switches cells on.
  • Waxing and threading the upper lip Repeated waxing over a patch darkens it.
  • Irritating skincare If it stings on a patch, it is adding to the problem.

What helps

  • Tretinoin or another retinoid Sheds pigmented skin cells faster.
  • Vitamin C and niacinamide Modest alone, useful alongside stronger treatments.
  • Careful chemical peels Light peels speed clearing, but gentle and spaced out.
  • Give it 12 weeks before judging it Pigment clears slowly; the first month looks like nothing.

What helps

  • Tranexamic acid Works on the vessel and signaling side, so it helps stubborn cases.
  • Stay on maintenance after it clears Stopping everything is what brings it back.

What makes it worse

  • Stopping treatment when it looks better A faded patch is still primed.

Your Routine

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Good skincare advice is hard to find. This routine is built on treatments with real evidence behind them, not on whatever happens to be trending.

Melasma
Melasma
AM
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PM
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How These Treatments Work

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Treatments for Melasma do not all work in the same place. Tap one to see where it acts.

Pick a treatment
Skin basics
BARRIEREPIDERMISDERMISPIGMENT CELLMELANOCYTESBLOCKS LIGHT REACHING SKINSLOWS PIGMENT MAKINGTURNS THE SIGNAL DOWNSPEEDS PIGMENT OUTREACHES DEEPER PIGMENT

Light switches pigment cells on. Nothing that fades a mark can outrun light landing on it every day.

Slows the enzyme the cell uses to make pigment, so less new pigment reaches the surface.

Works further upstream, on the message telling the cell to switch on.

Moves the top layer along faster, so pigment already made sheds sooner.

The wrong settings make melasma worse, so this is a specialist decision.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

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Everything here you can buy without seeing anyone.

A tinted mineral sunscreen
A tinted mineral sunscreen
Always
The single most useful thing on this page, and what makes everything else worth using. Broad spectrum, SPF 30 or higher, mineral and tinted: the iron oxides that give it color are what block visible light, and visible light drives melasma just as ultraviolet light does. A clear sunscreen does almost nothing to that part. A prescription cream worn without this loses ground every summer.
Five azelaic acid tubes and bottles on white, most marked 10 percent, from Peach Slices, Paula's Choice, Facetheory, The Ordinary and NaturiumDiagram: how Azelaic Acid 15% (Finacea) works in the skin
Moderate evidence
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.
Four cysteamine products: a Senté tube, an Omic+ cream and box, a 5% cysteamine serum dropper and a Cyspera bottle16:9 hero for Cysteamine. Never cropped: the tone strip and the corner logo depend on the full frame.
Moderate evidence
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.
Five serums lined up on white, labeled tranexamic acid or niacinamide with TXA, including SkinCeuticals Discoloration Defense16:9 hero for Tranexamic Acid. Never cropped: the tone strip and the corner logo depend on the full frame.
Moderate evidence
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.
Six niacinamide products on white, including The Ordinary 10% + Zinc 1%, Paula's Choice Booster and EltaMD UV ClearLabeled cutaway diagram of a single skin pore, headed Niacinamide. The epidermis is a brick-textured band across the top and the dermis is pink below it, with a yellow oil gland at the base of the pore and a small cluster of bacteria inside it. Two callout lines point in: decreases inflammation is drawn in dark navy as the main effect, and decreases oil production is drawn in gray as a lesser one. Nothing points at the dead cells blocking the pore.
Limited evidence
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.
Six vitamin C products on white, including La Roche-Posay, L'Oréal Revitalift, CeraVe, Vanicream, bliss and Olay16:9 hero for Vitamin C (L-Ascorbic Acid). Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
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.
Four alpha arbutin products lined up on white: three dropper serums and a pink cream tube16:9 hero for Alpha Arbutin. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
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.
Five kojic acid products on white, including a turmeric serum, Medicube capsule cream, Admire My Skin and Seoul Ceuticals16:9 hero for Kojic Acid. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
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.
Five licorice root products on white, including two Acwell bottles, Éminence, Horbäach liquid extract and Versed16:9 hero for Licorice Root Extract. Never cropped: the tone strip and the corner logo depend on the full frame.
Weak evidence
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.

Prescriptions

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The basics stay put - a gentle cleanser, a moisturizer and a daily sunscreen are right whichever kind you have.

These need a prescription.

A white cream tube lying on its side on a white background, with a plain white label reading Triple Combination and a blue swoosh beneath it.
Triple combination cream
Strong evidence
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.
16:9 hero for Hydroquinone 4%. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Hydroquinone 4% works in the skin
Strong evidence
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.
A plain white medicine tube lying at an angle on a white background, capped, labeled Tretinoin in black with a navy blue swoosh curving along its length.Diagram: how Tretinoin works in the skin
Moderate evidence
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 white cream tube lying on its side on a white background, with a plain white label reading Steroid Cream and a blue swoosh beneath it.
A steroid cream on its own
Weak evidence
Steroid creams do fade pigment for a while, which is why they turn up in unregulated lightening products, but they are not a melasma treatment. Used on the face for months they thin the skin, bring up broken vessels and can cause a rash around the mouth, and the pigment comes back when they stop. In melasma a steroid belongs only inside a supervised combination cream.
Five serums lined up on white, labeled tranexamic acid or niacinamide with TXA, including SkinCeuticals Discoloration Defense
Oral tranexamic acid
Moderate evidence
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.
A silver blister pack photographed flat on a white background, holding twenty-eight tablets in four rows of seven. The top three rows are white and the bottom row is pale peach, which is the week of inactive pills.
A review of hormonal contraception
Limited evidence
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.

Procedures

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These are done in the office, usually over several visits.

A small clear glass bowl holding a shallow pool of pale amber liquid on a white background, with a white fan-shaped brush lying beside it, bristles resting against the bowl.Diagram: how Chemical Peel works in the skin
Moderate evidence
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.
A gloved hand guiding a laser handpiece along a patient's lower leg16:9 hero for Nd:YAG Laser. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
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 gloved hand holding a picosecond laser handpiece against a woman's cheek as she lies on a treatment bed16:9 hero for Picosecond Laser. Never cropped: the tone strip and the corner logo depend on the full frame.
Limited evidence
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.
16:9 hero for Microneedling. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Microneedling works in the skin
Limited evidence
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.
16:9 hero for IPL (Intense Pulsed Light). Never cropped: the tone strip and the corner logo depend on the full frame.
IPL (Intense Pulsed Light)
Weak evidence
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.
16:9 hero for Fractional CO2 Laser. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Fractional CO2 Laser works in the skin
Weak evidence
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.

When to See a Dermatologist

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There is no rush with melasma, and most people can start alone — a tinted mineral sunscreen, shade, and something over the counter such as azelaic acid, niacinamide or vitamin C, for three months. If that changed nothing, book, because the treatments that reliably shift melasma are prescription-only. Go sooner if the patches are spreading, if they are changing how you feel about going out, if they started after a new medicine, if a previous treatment left the skin darker, or if you are not sure it is melasma, since other conditions cause facial pigment and some respond badly to melasma treatment. There is no blood test — the pattern does the work, with a Wood's lamp or lit magnifier used only to judge how deep the pigment sits.

— Dr. Schwarz, Board Certified Dermatologist

Complications

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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.

Lookalikes

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Post-Inflammatory Hyperpigmentation

Both are flat brown marks on the face and both show up more on deeper skin tones. The difference is the shape. Marks left by inflammation copy whatever came first, so they sit as separate spots where acne spots were, or in the outline of a rash, and they are rarely symmetric. Melasma is a spreading patch with soft edges that mirrors itself on both sides of the face. Plenty of people have both at the same time, and they are treated differently.

Sun Spots (Solar Lentigines)

Both are brown and both come from years of sun. Sun spots are separate, sharply outlined ovals a few millimetres across, scattered unevenly on whichever areas took the most sun. Melasma is a larger patch with blurred edges in a mirror-image pattern. The difference matters for treatment as much as for naming: sun spots answer well to lasers and freezing, and melasma often comes back darker after the same treatment.

Tinea Versicolor

A common yeast overgrowth that leaves flat patches which can be light brown, pink or paler than the skin around them, so it gets read as uneven pigment. It usually sits on the chest, back, shoulders and neck rather than the cheeks, it is not symmetric, and the patches show a fine dusty scale when they are scraped. It clears with an antifungal, which does nothing at all for melasma.

Myths

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  • "Melasma is just a stubborn tan and it will fade on its own." A tan fades because the pigment is temporary. In melasma the pigment cells stay switched on and some pigment sits deeper, so it lightens in winter and returns rather than clearing.
  • "It is called liver spots, so something is wrong with my liver." That nickname belongs to sun spots, and it is wrong about those too. Neither has anything to do with the liver.
  • "My phone and computer screens are causing my melasma." Visible light does drive melasma, but a screen puts out a fraction of what comes through a window on an overcast day. Daylight is what to manage.
  • "A stronger laser would clear it faster." Melasma is where aggressive treatment most often backfires. High-energy lasers inflame the skin and can leave it darker. When they are used here, it is at low settings, alongside creams.
  • "Once it clears I can stop everything." The cells stay primed even when the skin looks even. Stop sun protection and treatment and most people see it return within a season or two.
  • "I have deep skin, so I do not need sunscreen." Melasma is more common in deeper skin tones, and visible light drives it harder there. Sunscreen matters more here, not less, and tinted mineral is the version that works.
  • "Hydroquinone is banned because it is dangerous." Hydroquinone is still mainstream prescription treatment worldwide. The concern is unsupervised, high-strength, long-term use in unregulated products. In supervised courses with breaks it has a long track record.

Questions Patients Ask

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Will melasma ever go away completely?

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.

How long before I see anything?

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.

Do I really have to wear sunscreen indoors?

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.

Is it safe to treat melasma while pregnant?

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.

Will a laser fix it in one session?

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.

Why did mine come back after it cleared?

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.

References

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