Your Essential Guide to Melasma and More
Doctor’s Note
As dermatologists, we understand that struggling with melasma can be frustrating. The dark spots can cause individuals to feel self-conscious about their appearance, leading to a negative impact on their self-esteem and confidence. We understand that finding the right treatments can be overwhelming, but we hope to provide guidance. Watch our video to the right, or scroll on if you want to skip to the recs!
What is Melasma?
Melasma is a common skin condition that causes brown or grayish-brown patches, usually on the face. These patches often appear on the cheeks, bridge of the nose, forehead, chin, and above the upper lip. Melasma can also appear on other parts of the body that get a lot of sun, like the forearms and neck. It’s more common in women than men and is often called the "mask of pregnancy" because it frequently affects pregnant women.
Melasma Pictures
The main symptom of melasma is the appearance of dark, discolored patches on your skin. These patches are usually:
Brown or gray-brown
Irregular in shape
Often symmetrical, meaning they appear equally on both sides of your face
Melasma doesn't cause any physical pain or discomfort, but the patches can be bothersome for cosmetic reasons.
What Causes Melasma?
Melasma is thought to be caused by the overproduction of melanin, the pigment that gives your skin its color. Several factors can contribute to this, including:
Sun Exposure: UV rays from the sun stimulate melanocytes, the cells in your skin that produce melanin.
Hormonal Changes: Pregnancy, birth control pills, and hormone replacement therapy can trigger melasma.
Genetics: If someone in your family has melasma, you’re more likely to get it.
Skin Type: People with darker skin are more prone to melasma because they have more active melanocytes.
Medications and Cosmetics: Some drugs and skincare products can cause photosensitivity, making your skin more susceptible to melasma.
Melanocyte Basics
If you took our Skin Basics 101 course, you are already an expert on melanocytes! As a reminder, our skin color comes from cells called melanocytes, which produce melanin to give us our skin color. Sometimes, melanocytes work perfectly to provide an even color. However, in melasma, various triggers can cause melanocytes to overproduce melanin and cause dark spots.
So, if our melanocytes are working overtime, how do we stop them? We intervene in the pigment production process! We can target four specific steps to prevent dark spots. What ingredients do we use to intervene? Check below! You'll see many familiar ingredients. It's best to use a combination of these to maximize the effectiveness of your routine.
Notice any repeat ingredients in the steps above? That's right, it's our old friend retinol! Retinol combats melasma in multiple steps and is a great addition to any melasma-fighting routine. But be careful not to overuse it, as irritation from retinol can worsen melasma. It's all about finding the right balance! 😣
What Makes Melasma Worse?
Several factors can make melasma worse, including:
Sun Exposure: UV light from the sun can make melasma more noticeable.
Hormonal Changes: Pregnancy, birth control pills, and hormone therapy can all worsen melasma.
Stress: High-stress levels can affect your hormones and might make melasma worse.
Certain Skincare Products: Products that irritate your skin or cause photosensitivity can exacerbate melasma.
What Makes Melasma Better?
To improve melasma, you should:
Protect Your Skin from the Sun: Wear sunscreen with an SPF of 30 or higher every day. Broad-spectrum sunscreens protect against both UVA and UVB rays. Wear a wide-brimmed hat and sunglasses to shield your face from the sun.
Avoid Irritants: Use gentle skincare products and avoid anything that irritates your skin.
Follow Treatment Plans: Stick to the treatments your doctor recommends, which might include topical medications, procedures, or lifestyle changes.
Step-by-Step Instructions to Manage Melasma Flares
Daily Sun Protection: Apply a broad-spectrum sunscreen with at least SPF 30 every morning, even on cloudy days. Reapply every two hours if you’re outside.
Wear Protective Clothing: Use a wide-brimmed hat and sunglasses to protect your face.
Gentle Skincare Routine: Use mild cleansers and moisturizers to avoid irritating your skin.
Topical Treatments: Apply prescribed creams or ointments as directed by your doctor.
Avoid Heat and Light: Try to stay in the shade and avoid activities that cause excessive sweating, as heat can worsen melasma.
Healthy Diet and Hydration: Eat a balanced diet and drink plenty of water to support skin health.
Melasma Treatment Overview
Managing melasma can be challenging, but understanding the right treatment approach can make a significant difference. This graphic will walk you through the most effective ingredients and strategies to help manage and reduce the appearance of melasma.
For some conditions, we have a very specific step-by-step treatment list that we carefully follow. Melasma is not one of those conditions. Melasma is very specific to each individual patient. What works for one patient may or may not work for the next. It’s a very frustrating condition to treat!
Treating melasma often needs a mix of different treatments to tackle the pigmentation from all angles. You can use topical treatments like hydroquinone and tretinoin, along with newer options like tranexamic acid. By including these in your skincare routine, you can effectively manage and reduce melasma.
When topicals do not work, we turn to chemical peels and lasers. These procedures are not our first option. We prefer to manage melasma with a great sun protection routine + a great topical routine.
Best Products for Melasma
Sun protection is *very* important for patients with melasma. Sun exposure exacerbates dark patches, and prolonged exposure can worsen dark patches to the point where medications/procedures do not work. Thus, consistent use of broad-spectrum sunscreens with SPF 50 or higher, coupled with protective clothing and sun avoidance strategies, is crucial to manage melasma. Look for tinted sunscreens with iron oxide (the ingredient often used to impart color to tinted sunscreens) to protect against blue light (ie from computer monitor). Apply three finger-lengths of sunscreen to face. Reapply every two to three hours.
Best Sunscreens for Melasma
Look for tinted sunscreens.
Best Products for Melasma
Look for brightening ingredients.
Do NOT wear metal-frame aviators when you have melasma. The metal can heat up, worsening your dark spots! 😎
Best Prescriptions for Melasma
Melasma has several prescription treatment options. The most commonly prescribed is hydroquinone, a skin-lightening agent that reduces the appearance of dark spots by inhibiting melanin production (via tyrosinase). While hydroquinone is effective in lightening dark spots, it comes with certain risks (see below). When we do prescribe hydroquinone, we usually prescribe in a “Two months on, one month off” fashion (so you don’t overuse it!).
Hydroquinone
"Gold Standard" dark spot lightener
Only apply to dark spots
In the US, hydroquinone used to be over-the-counter. It is now prescription only.
Side effects: skin irritation, lightening, dryness, and burning, rare skin darkening
Don't overuse due to hydroquinone risk
Tri-Luma
Tri-Luma combines 3 ingredients to fight melasma:
Fluocinolone (decreases inflammation)
Hydroquinone (reduces dark spots)
Tretinoin (reduces dark spots)
Only apply to dark spots
Don't overuse due to hydroquinone risk
Refrigerate
Tranexamic Acid
Reduces blood vessel growth and inflammation in the skin
Helps decrease melasma pigmentation
Requires a prescription
Possible side effects include nausea and stomach pain
Not suitable for everyone, especially those with a history of blood clots
Azelaic Acid
Reduces dark spots and inflammation
Inhibits melanin production
Kills acne-causing bacteria
Side Effects: Can cause mild irritation or dryness
Note: Azelaic Acid <10% is over-the-counter. 15-20% is prescription only.
Some countries have banned or restricted the use of hydroquinone because of concerns about its safety. Because people often misuse hydroquinone due to its skin-lightening effects, many regions have made it available only by prescription to regulate its use more strictly.
Procedures for Melasma
Melasma is a condition that we tend to treat with topicals first and use procedures only if your topical routine is unsuccessful. Here are some of our favorite procedures for melasma:
Chemical Peels
Peels involve the application of an acid to remove the top layers of the skin. Typically, six sessions every 2 – 4 weeks can help with melasma.
Laser
A laser called a Q-Switch ND Yag laser might help with melasma. At low energy, it destroys the "tentacles" of the melanocyte, so it can't spread pigment to the rest of the skin. You might need a few sessions, and wearing sunscreen is very important if you get this laser treatment.
Microneedling
Microneedling is a procedure where fine needles penetrate the skin. When combined with a medication called tranexamic acid, microneedling can lighten melasma. Typically, about 4-6 treatments are required.
PS. Doctor’s Summary Note
Melasma is TOUGH. It is chronic. We can’t give you a pill to “get rid of it.” You really just have to be VERY diligent about your sun protection. Even a few hours in the sun can flare melasma. If you can change your birth control/medications, that can help. For some conditions, we have easy procedures that can zap it away. Melasma is not one of them. You have to tinker around with your topical routine with brightening ingredients to lighten dark spots. It’s a tough condition to have! 😣 But can be controlled with mostly over-the-counter products! 😊
Melasma FAQs
How to Get Rid of Dark Skin Above the Upper Lip?
To get rid of dark skin above the upper lip, you can try using a brightening cream with ingredients like niacinamide or vitamin C. Sunscreen is also essential to prevent further darkening. If the discoloration persists, consult a dermatologist for treatments like chemical peels or laser therapy.
How to Cover Dark Patches on the Face?
To cover dark patches on your face, start with a color-correcting concealer. Use a peach or orange tone to neutralize dark areas, then apply your regular foundation over it. Setting powder can help keep everything in place.
How to Get Rid of Melasma Mustache?
Treating a melasma mustache involves using brightening ingredients like hydroquinone, azelaic acid, or tranexamic acid. Consistent use of sunscreen is critical to prevent it from worsening. For persistent cases, consider professional treatments like chemical peels or laser therapy.
How to Hide Dark Marks on the Face?
You can hide dark marks on your face using a concealer that matches your skin tone. Apply it over the dark spots, and then blend it in with your foundation. A setting powder can help the coverage last throughout the day.
How to Get Rid of Dark Spots Around the Mouth?
Dark spots around the mouth can be lightened with products containing ingredients like vitamin C, retinoids, or glycolic acid. Regular exfoliation and daily use of sunscreen can also help prevent further darkening.
What Is the Fastest Way to Cure Melasma?
There isn’t a quick fix for melasma, but the fastest way to see improvement is by using a combination of prescription-strength lightening creams, consistent sunscreen use, and avoiding sun exposure. In-office treatments like chemical peels or laser therapy can also speed up results.
How Long Does It Take for Pigmentation to Go Away?
Pigmentation can take several weeks to months to fade, depending on the cause and severity. Using brightening products consistently and protecting your skin from the sun can help speed up the process.
How to Get Rid of Dark Patches on the Face Overnight?
While it's unlikely to completely remove dark patches overnight, using a potent brightening serum or mask containing ingredients like vitamin C or niacinamide can help improve their appearance. Regular use over time will provide more noticeable results.
How to Reduce Black Spots on the Nose?
To reduce black spots on your nose, consider using products with ingredients like salicylic acid, retinoids, or niacinamide. Regular exfoliation and sunscreen use are also important to prevent further darkening.
Why Do I Have a Dark Spot on My Lip?
A dark spot on your lip could be caused by hyperpigmentation, sun exposure, or even a minor injury. Applying sunscreen to your lips and using a lightening balm or cream can help fade the spot over time.
Why Is the Skin Around My Mouth Dark?
The skin around your mouth might be darker due to hyperpigmentation, irritation, or hormonal changes. Using brightening products, exfoliating regularly, and protecting the area from the sun can help lighten the skin.