Melasma is a common skin condition that causes brown, tan, or grayish-brown patches on the skin, most often on the face. It is not contagious or dangerous to your physical health, but it can be persistent and may significantly affect self-esteem and quality of life.

Melasma is especially common in people with medium to darker skin tones and is more common in women, particularly during the reproductive years. Sun exposure, hormonal changes, genetics, and other factors can contribute to its development.

The good news is that melasma can often be improved and controlled with consistent treatment and sun protection. However, there is no guaranteed permanent cure, and pigmentation can return.

This guide explains what melasma looks like, what causes it, how dermatologists diagnose it, available treatments, and what you can do to prevent it from getting worse.

What Is Melasma?

Melasma is a chronic acquired skin condition that causes areas of increased pigmentation, usually on the face.

It develops when melanocytes, the cells responsible for producing melanin, become more active and produce excess pigment.

Melasma commonly appears as flat, irregular patches that are:

Light brown
Dark brown
Tan
Grayish-brown
Bluish-gray in some people with darker skin tones

The patches are usually symmetrical, meaning they appear on both sides of the face.

Common areas include the:

Cheeks
Forehead
Nose
Upper lip
Chin
Jawline

Melasma is sometimes called the “mask of pregnancy” because hormonal changes during pregnancy can trigger it. The medical term chloasma is also sometimes used for pregnancy-associated melasma.

Is melasma dangerous?

No. Melasma itself is generally harmless and is not contagious, an infection, or skin cancer.

However, its visible appearance can have a real emotional impact. Research and dermatology organizations recognize that melasma can affect self-esteem, social interactions, and quality of life.

If a dark spot is raised, bleeding, painful, rapidly changing, or very different from your other pigmentation, do not assume it is melasma. A dermatologist should examine it because several other skin conditions can resemble facial pigmentation.

Who Is Most Likely to Develop Melasma?

Melasma can affect people of any sex or skin tone, but certain groups have a higher risk.

It is more common among:

Women
People between approximately 20 and 40 years of age
People with medium to darker skin tones
People who tan easily
People with a family history of melasma
People exposed to significant sunlight
People experiencing hormonal changes

Melasma is particularly common among people of Asian, Latin American, African, Middle Eastern, Mediterranean, and other backgrounds with more pigmented skin.

The American Academy of Dermatology reports that more than 5 million people in the United States are affected by melasma.

Types of Melasma

Dermatologists can describe melasma according to where the pigment is located in the skin and where the patches appear on the face.

Types Based on Pigment Depth

1. Epidermal Melasma

Epidermal melasma involves increased pigment primarily in the epidermis, the outer layer of the skin.

It often appears:

Dark brown
More clearly defined
More responsive to treatment than deeper pigmentation

A Wood’s lamp examination may make epidermal pigmentation more noticeable.

2. Dermal Melasma

Dermal melasma involves pigment deeper in the skin, within the dermis.

It may appear:

Light brown
Gray
Bluish-gray
Less clearly defined

Because the pigment is deeper, treatment can be more difficult.

3. Mixed Melasma

Mixed melasma contains features of both epidermal and dermal pigmentation.

It is commonly encountered in clinical practice and may respond partially to treatment.

4. Indeterminate Melasma

In some people, particularly those with darker skin tones, the depth of pigmentation cannot be clearly determined using a Wood’s lamp. This may be described as indeterminate melasma.

Importantly, these classifications are useful for understanding pigmentation, but they do not always predict exactly how an individual person will respond to treatment.

Melasma Patterns on the Face

Dermatologists also classify melasma according to its distribution.

Centrofacial Melasma

This is the most common pattern.

Pigmentation can involve the:

Forehead
Cheeks
Nose
Upper lip
Chin

Malar Melasma

Pigmentation is concentrated mainly around the:

Cheeks
Nose

Mandibular Melasma

Pigmentation appears around the:

Jawline
Lower face

Melasma can also occur outside the face, including on the neck, arms, or other sun-exposed areas, although facial melasma is much more typical.

What Causes Melasma?

There is no single cause of melasma.

Researchers believe it develops through a combination of factors that make melanocytes more active. These include sun exposure, visible light, hormonal influences, genetic susceptibility, and other factors affecting the skin.

1. Sun Exposure

Sunlight is one of the most important factors associated with melasma.

Ultraviolet radiation stimulates melanin production. Continued exposure can make existing pigmentation darker and may contribute to recurrence after treatment.

This is one reason melasma often becomes more noticeable during periods of increased sun exposure.

2. Visible Light

Visible light can also contribute to pigmentation, particularly in people with darker skin tones.

Current evidence supports the role of visible light in worsening melasma. This is why dermatologists may recommend tinted sunscreen containing iron oxides, in addition to broad-spectrum UV protection.

This does not mean that ordinary indoor screen exposure is automatically the main cause of melasma. The strongest concern remains meaningful exposure to sunlight and other sources of visible light.

3. Hormonal Changes

Hormonal changes can trigger melasma in susceptible people.

Common situations include:

Pregnancy
Oral contraceptive use
Hormone therapy
Other hormonal changes

During pregnancy, increased estrogen and progesterone are believed to contribute to melanocyte activation.

Pregnancy-associated melasma may improve after delivery, although it does not always disappear completely.

4. Genetics

Genetic susceptibility appears to play an important role.

People with a close relative who has melasma may have a higher risk of developing it.

In one study cited by the AAD, 48% of 324 people with melasma reported having a blood relative with the condition.

5. Skin Tone

Melasma occurs more frequently in people with medium to darker skin tones.

The reason is related partly to how melanocytes respond to environmental and hormonal triggers.

People with darker skin may also be more susceptible to visible-light-induced pigmentation and post-inflammatory hyperpigmentation.

6. Thyroid Disease

Some research has found an association between melasma and thyroid disorders, including autoimmune thyroid disease.

However, having melasma does not automatically mean you have a thyroid problem.

If you have symptoms or other reasons to suspect thyroid disease, a healthcare professional can decide whether testing is appropriate.

7. Certain Medications

Some medications may contribute to melasma or make pigmentation more noticeable.

Examples can include:

Some anti-seizure medications
Oral contraceptives
Certain medications that increase sensitivity to sunlight
Some antibiotics

Do not stop a prescribed medication because of melasma without discussing it with the prescribing healthcare professional.

8. Skin Irritation and Inflammation

Irritation can make pigmentation problems worse.

Aggressive exfoliation, irritating skincare products, burns, or poorly selected procedures may cause inflammation and post-inflammatory hyperpigmentation, which can make the overall pigmentation more difficult to manage.

For this reason, gentle skincare is an important part of melasma care.

9. Stress

Stress has been investigated as a possible melasma trigger, but the evidence is less certain than it is for sunlight and hormonal factors.

The AAD describes the relationship between stress and melasma as an area where research is still developing.

What Does Melasma Look Like?

Melasma usually causes flat, darker patches rather than bumps or a rash.

Typical features include:

Brown, tan, or grayish-brown pigmentation
Irregular or uneven borders
Symmetrical patches
Gradual development
No significant pain or itching

Common locations include:

Cheeks
Forehead
Nose
Upper lip
Chin
Jawline

Melasma can sometimes occur on the neck, arms, or other sun-exposed areas.

What Melasma Usually Does Not Cause

Melasma generally does not cause:

Bleeding
Oozing
Significant pain
Raised lesions
Blisters
Open sores

If pigmentation is rapidly changing, bleeding, painful, raised, or otherwise unusual, a dermatologist should evaluate it rather than assuming it is melasma.

Does Melasma Affect Quality of Life?

Yes.

Although melasma does not usually cause physical symptoms, the visible pigmentation can affect how people feel about their appearance.

Some people report:

Lower self-confidence
Embarrassment
Frustration with treatment
Avoiding photographs
Reduced social interaction

The psychological impact should not be dismissed simply because melasma is medically harmless. The AAD specifically recognizes its effect on self-esteem and quality of life.

How Is Melasma Diagnosed?

A dermatologist can often diagnose melasma by examining the skin.

The diagnosis is usually based on:

The appearance of the pigmentation
Its distribution
Your medical and medication history
Your skin type
Possible triggers

Wood’s Lamp Examination

A dermatologist may use a Wood’s lamp, a specialized ultraviolet light, to examine pigmentation.

It can help provide information about the depth of pigment and may support treatment planning. A dermatoscope may also be used.

Skin Biopsy

A biopsy is not usually necessary when melasma has a typical appearance.

However, if the diagnosis is uncertain, a dermatologist may remove a small sample of skin to rule out other conditions that can resemble melasma.

Melasma Treatment

There is no single treatment that works for everyone.

Current evidence and expert consensus support a combination approach, usually beginning with consistent photoprotection and appropriate topical treatment. Procedures or oral medication may be considered for selected patients.

Treatment should be personalized according to factors such as:

Skin tone
Severity
Duration of melasma
Pigment depth
Pregnancy status
Medications
Previous treatments
Risk of post-inflammatory hyperpigmentation

1. Sun Protection: The Foundation of Treatment

Sun protection is one of the most important parts of melasma management.

Dermatologists commonly recommend:

Broad-spectrum sunscreen with SPF 30 or higher
Daily use
Reapplication at least every 2 hours when outdoors
Seeking shade
Wearing a wide-brimmed hat
Wearing sun-protective clothing
Avoiding tanning beds and sunlamps

For melasma, a tinted sunscreen containing iron oxides can provide additional protection against visible light.

You do not necessarily need SPF 50+ specifically for melasma. Consistent use of an appropriate broad-spectrum sunscreen matters greatly, and higher SPF products can be reasonable when used correctly.

2. Hydroquinone

Hydroquinone is one of the best-established topical treatments for melasma.

It works primarily by reducing melanin production.

Depending on the country, formulation, and concentration, hydroquinone may require a prescription.

It should be used according to medical guidance because prolonged or inappropriate use can cause irritation and, rarely, exogenous ochronosis, a condition that can cause persistent dark or blue-black discoloration.

3. Tretinoin and Other Retinoids

Tretinoin is a prescription retinoid that can be used as part of a melasma treatment plan.

It helps increase skin-cell turnover and can improve the effectiveness of other topical treatments.

Because retinoids can cause irritation, dryness, and increased sensitivity, they should be introduced carefully.

Important: topical retinoids such as tretinoin are generally avoided during pregnancy unless a healthcare professional specifically advises otherwise.

4. Triple-Combination Cream

A prescription triple-combination cream contains:

Hydroquinone
Tretinoin
A topical corticosteroid

This combination has strong clinical evidence for melasma and remains an important treatment option under medical supervision. International expert consensus continues to identify hydroquinone-based triple combination therapy as a key treatment.

Because it contains a corticosteroid and hydroquinone, it should not be used indefinitely without medical supervision.

5. Azelaic Acid

Azelaic acid can help reduce pigmentation and is another option for people who cannot tolerate or should not use certain stronger treatments.

It is also commonly used for acne and post-inflammatory pigmentation.

Your dermatologist can determine whether it is appropriate for your skin and circumstances.

6. Kojic Acid

Kojic acid can interfere with melanin production and is found in some skincare products designed for hyperpigmentation.

It may be useful as part of a broader treatment plan, although its effectiveness can vary.

7. Vitamin C and Other Topical Ingredients

Vitamin C and other pigment-targeting ingredients may be used as adjunctive treatments.

Other ingredients investigated or used in melasma management include:

Tranexamic acid
Cysteamine
Thiamidol
Azelaic acid
Kojic acid

Evidence varies between treatments, formulations, and studies, so an ingredient being marketed for “brightening” does not automatically mean it will treat melasma effectively.

Tranexamic Acid for Melasma

Tranexamic acid (TXA) is an increasingly studied treatment for melasma.

It can be used topically, and dermatologists may prescribe it orally for selected patients with difficult-to-treat melasma.

Clinical research has found that oral tranexamic acid can improve melasma in some patients, particularly when standard topical treatments have not provided adequate results.

However, oral tranexamic acid is not appropriate for everyone.

Before prescribing it, a dermatologist should review factors such as:

Personal history of blood clots
Risk factors for thrombosis
Other medications
Medical history

More recent research continues to examine its safety and appropriate patient selection.

Do not take oral tranexamic acid for melasma without medical supervision.

Chemical Peels

Chemical peels may be used as an additional treatment for melasma.

Depending on the treatment plan, dermatologists may use agents such as:

Glycolic acid
Salicylic acid
Lactic acid
Other professionally selected peeling agents

Peels can cause irritation and post-inflammatory hyperpigmentation, particularly in people with darker skin.

For this reason, melasma peels should be performed by an appropriately trained medical professional who understands pigmentation disorders and skin of color.

Microneedling

Microneedling has been studied as an additional treatment for melasma, including in combination with topical medications.

It may help improve treatment response in selected patients.

However, it is a procedure that can cause inflammation and pigmentation changes if performed incorrectly. It should therefore be considered as part of a dermatologist-guided treatment plan rather than as a routine DIY procedure.

Laser and Light Treatments

Laser and light-based treatments may help some people with melasma, but they require caution.

The major concern is that procedures can sometimes worsen pigmentation or trigger post-inflammatory hyperpigmentation.

This is particularly important for people with darker skin tones.

Current expert recommendations generally place laser treatment later in the treatment pathway, particularly for melasma that has not responded adequately to more established treatments.

Do not choose a laser simply because it is advertised as the “best laser for melasma.”

The appropriate device, settings, treatment interval, skin type, and experience of the provider all matter.

Can Melasma Be Treated During Pregnancy?

Pregnancy changes the treatment approach.

Pregnancy-related melasma may improve naturally after delivery, so aggressive treatment is often unnecessary during pregnancy.

Some commonly used melasma medications are not appropriate during pregnancy.

If you are pregnant or trying to become pregnant, talk with your obstetrician or dermatologist before using prescription or over-the-counter treatments for pigmentation. The AAD specifically advises caution because it can be difficult to know whether a nonprescription melasma treatment is safe during pregnancy.

Sun protection remains an important part of care.

Melasma Treatment for Darker Skin

Melasma is common in people with darker skin tones, but treatment requires particular care because aggressive procedures can cause additional pigmentation.

People with darker skin may benefit from:

Consistent broad-spectrum sunscreen
Tinted sunscreen containing iron oxides
Gentle skincare
Carefully selected topical treatments
Conservative use of chemical peels
Carefully selected procedures performed by experienced professionals

The goal is not simply to remove pigment quickly. The goal is to improve pigmentation without causing additional inflammation or hyperpigmentation.

How Long Does Melasma Treatment Take?

Melasma usually does not disappear overnight.

The AAD notes that people may need approximately 3 to 12 months to see treatment results, and longer-standing melasma may take more time.

Your results can depend on:

How long you have had melasma
Your skin tone
Pigment depth
Sun exposure
Hormonal triggers
Treatment adherence
Previous treatments
Individual response

A realistic goal is usually gradual improvement and long-term control, rather than a permanent overnight cure.

Can Melasma Come Back?

Yes.

Melasma is considered a chronic and recurrent condition.

Even after successful treatment, pigmentation can return, particularly after:

Significant sun exposure
Hormonal changes
Pregnancy
Stopping maintenance treatment
Other individual triggers

This is why long-term photoprotection is important even after the skin looks clearer.

How to Prevent Melasma From Getting Worse

You cannot prevent every case of melasma, especially when genetics or hormonal changes are involved.

However, you can reduce common triggers and help prevent recurrence.

Practical daily habits

Use broad-spectrum sunscreen every day.
Choose tinted sunscreen with iron oxides if visible-light protection is important for your skin.
Reapply sunscreen when spending extended time outdoors.
Wear a wide-brimmed hat and protective clothing.
Seek shade when possible.
Avoid tanning beds and sunlamps.
Use gentle, fragrance-free skincare if your skin is easily irritated.
Avoid aggressive exfoliation.
Do not stop prescription medication without discussing it with your doctor.
Follow your dermatologist’s maintenance treatment plan.

AAD guidance specifically recommends daily sun protection, gentle skincare, and tinted sunscreen containing iron oxide for people with melasma.

Does Diet Cause or Cure Melasma?

There is currently no strong evidence that a particular food or diet directly causes or cures melasma.

A balanced diet supports general health and skin health, but changing your diet should not replace evidence-based melasma treatment.

Be cautious with products or supplements marketed as an “internal cure” for melasma.

Should You See a Dermatologist for Melasma?

Consider seeing a dermatologist if:

You are not sure whether the pigmentation is melasma.
The patches are spreading or changing.
Over-the-counter products have not helped.
The pigmentation is affecting your quality of life.
You are considering hydroquinone or prescription treatment.
You are considering chemical peels, microneedling, or laser treatment.
You have darker skin and are concerned about post-inflammatory hyperpigmentation.
You are pregnant or planning pregnancy.
You are considering oral tranexamic acid.

A dermatologist can confirm the diagnosis and develop a treatment plan based on your skin type, triggers, pigmentation pattern, and previous treatments.

What Dermatologists Emphasize About Melasma

Current dermatology guidance has several consistent themes:

Sun protection matters. Continued exposure to sunlight can darken melasma and contribute to recurrence.

Treatment usually requires patience. Melasma is chronic and can take months to improve.

Combination treatment is common. Dermatologists may combine photoprotection with topical medications and, in selected patients, procedures or systemic treatment.

More aggressive treatment is not always better. Irritation and inflammation can make pigmentation worse.

Treatment should be individualized. Skin tone, pigment depth, pregnancy status, medical history, and previous treatment all matter.

Frequently Asked Questions About Melasma

Is melasma permanent?

Not necessarily. Melasma can improve significantly and sometimes fade when a trigger is removed. However, it can persist for years and may return after treatment, particularly with sun exposure or hormonal changes.

Can men get melasma?

Yes. Melasma can affect men as well as women, although it is more common in women.

Can melasma go away after pregnancy?

It can. Pregnancy-related melasma may fade after delivery as hormone levels change, but it does not always disappear completely. Sun exposure can also make the pigmentation persist.

What is the fastest way to get rid of melasma?

There is no reliable overnight treatment.

The most evidence-supported approach generally starts with consistent photoprotection and appropriate topical treatment. Dermatologists may add other treatments when needed. Results commonly take months rather than days.

Is sunscreen really necessary for melasma?

Yes. Sun protection is a central part of melasma treatment because sunlight can worsen pigmentation and contribute to recurrence.

Is tinted sunscreen better for melasma?

Tinted sunscreen containing iron oxides can provide protection against visible light in addition to UV protection. This may be particularly useful for people with darker skin tones who are prone to pigmentation.

Can I treat melasma at home?

Some topical products can be used at home, but the appropriate treatment depends on the cause and severity of your pigmentation.

Gentle skincare and daily sun protection are reasonable foundations. Stronger treatments such as hydroquinone, tretinoin, or oral tranexamic acid should be discussed with a qualified healthcare professional.

Is hydroquinone safe for melasma?

Hydroquinone is an established treatment for melasma, but it should be used appropriately and according to medical guidance. Prolonged or inappropriate use can cause adverse effects, including rare exogenous ochronosis.

Can laser treatment permanently remove melasma?

No treatment can guarantee permanent removal.

Lasers may improve melasma in selected patients, but they can also cause worsening or recurrence. Current expert recommendations generally reserve laser treatment for selected or refractory cases and emphasize careful patient selection.

Is oral tranexamic acid safe for melasma?

Oral tranexamic acid can be effective for selected patients, but it is a prescription treatment that requires medical assessment.

A dermatologist should review your personal risk factors, including a history of blood clots and other potential contraindications, before prescribing it.

Does melasma mean I have a hormone problem?

Not necessarily.

Hormonal changes can contribute to melasma, but many other factors are involved, including sunlight and genetic susceptibility. Melasma alone does not prove that you have a hormonal disorder.

Does melasma mean I have thyroid disease?

No.

Some research has found an association between melasma and thyroid disease, but most people with melasma do not automatically need thyroid testing. Your healthcare professional can determine whether testing is appropriate based on your symptoms and medical history.

Key Takeaways

Melasma is a common pigmentation disorder that usually affects the face.
It causes flat brown, tan, or grayish-brown patches, often symmetrically.
Sun exposure is a major trigger, while hormones, genetics, skin tone, medications, and other factors can contribute.
Melasma is not contagious and is generally not dangerous, but it can significantly affect quality of life.
Daily sun protection is a cornerstone of treatment.
Tinted sunscreen containing iron oxides can help protect against visible light.
Treatment may include hydroquinone, tretinoin, triple-combination cream, azelaic acid, kojic acid, tranexamic acid, and selected procedures.
Chemical peels, microneedling, and lasers should be selected carefully because irritation can worsen pigmentation.
Oral tranexamic acid should only be used under medical supervision.
Melasma often takes months to improve and can return after successful treatment.
The best treatment depends on your skin tone, pigmentation pattern, triggers, medical history, and previous treatments.

Trusted Sources

The information in this article is based on established dermatology and medical references, including:

American Academy of Dermatology (AAD) — patient guidance on melasma causes, diagnosis, treatment, and self-care.
DermNet — clinical information on melasma, diagnosis, pigmentation patterns, and treatment.
PubMed-indexed medical literature — research and reviews concerning melasma and treatments such as tranexamic acid.
International expert consensus — recent recommendations covering photoprotection, topical therapies, procedures, and systemic treatment.

Medical Disclaimer

This content is for informational purposes only and not a substitute for professional medical advice. Always consult a qualified dermatologist for concerns about your skin.