Melasma: What Causes It and How Is It Treated?

Author: Leanne Maria Braganca, MDS

Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Melasma is a common condition characterised by brown patches on the skin. 
• Some known triggering factors that can cause melasma include genetics, exposure to the sun, pregnancy, hormones, certain cosmetics, and some medications.
• It commonly appears on sun-exposed skin, such as the face and forearms. 
• Melasma is symptom-free and is not associated with pain or itching. 
• It is not an allergic reaction, contagious, nor does it turn into skin cancer.
• There is no complete cure for melasma, but there are several treatment options and procedures that may improve its appearance. 

Introduction 

We live in times when everyone is attempting to be more health-conscious and take better care of themselves. These efforts have extended beyond general health, with people even taking care of their overall wellness and mental health too. There is a growing understanding of how some problems are not just ‘skin-deep’. They can affect a person’s well-being in different ways.

Melasma is one such chronic skin condition that affects around 1% of the global population. It is characterised by flat brown patches that occur on sun-exposed areas of the body, particularly the face. It occurs more commonly in women, particularly those of childbearing age with a darker skin type [1]. 

While melasma isn't painful and doesn't pose any health risks, it can cause significant emotional distress because of its effect on a person’s facial appearance.

This article explains what melasma is, the factors that contribute to or put you at risk for melasma, as well as how to prevent it from happening. It also outlines the signs to look out for and the treatment strategies that are used to manage melasma.

What Is Melasma?

Melasma presents as hyperpigmented patches where the skin appears darker than the rest of the skin around them. These patches are distributed symmetrically on areas exposed to the sun, such as the:

• Upper lip
• Chin
• Forehead
• Less commonly, they can occur on other areas of the body, including the forearms, back, neck, and sternum [2]. 

Melasma is not contagious, not painful or itchy, and is a harmless condition. However, since it affects a person’s appearance, it can cause emotional distress and affect a person’s quality of life. Patients commonly report feelings of shame, low self-esteem,  dissatisfaction, and a lack of motivation to go out [3].  

What Causes Melasma?

Melasma occurs when the pigment-producing cells in the skin create excess melanin.This is believed to be caused by multiple factors, including [3,4,5]:

• Exposure to sunlight

Ultraviolet rays from the sun stimulate the pigment-producing cells in the skin (known as the ‘melanocytes’) to produce excess melanin. This can lead to darkening of existing melasma patches or formation of new ones.

Melasma pigmentation usually improves in the winter and worsens in the summer (or immediately after intense sun exposure).  

• Genetics

40% of patients reported having relatives affected with the disease. 

• Hormonal factors

Fluctuations in levels of hormones, especially female sex hormones ( due to oral contraceptive use, hormone replacement therapy, or pregnancy), can increase melanin production and lead to melasma.

Melasma during the second trimester of pregnancy is known as “mask of pregnancy” or “chloasma gravidarum”. In these cases, melasma is temporary and resolves within a year after delivery. However, it can recur during subsequent pregnancies.

• Medications

Taking medications such as birth control pills, steroids, clomipramine, and phototoxic drugs (that make the skin sensitive to sunlight), such as retinoids.

• Thyroid disorders

Conditions such as Hashimoto’s thyroiditis and Graves’ disease can lead to altered levels of thyroid hormones, which may influence melanocyte activity and result in melasma

Who Is More Likely to Develop Melasma? 

Some people are more likely to develop melasma than others. These include: [3,6]

• Women of childbearing age
• Patients with darker skin tones
• Women experiencing hormonal fluctuations (due to medications such as birth control pills, hormonal replacement therapy)
• Patients with a family history of melasma
• Patients with long-term exposure to sunlight:

Photoaging (premature ageing of the skin caused by long-term sun exposure) can affect the skin’s ability to heal and repair. This can prolong melasma and make it harder to treat. 

How Is Melasma Diagnosed? 

Melasma is diagnosed and differentiated from other similar-looking skin conditions based on: [3,7]

• Detailed history 

• Onset

Typically gradual 

• How long it’s been present
• Known triggers

• Cumulative sun exposure: history of episodic worsening during periods of increased UV or visible-light exposure
• Hormonal history: pregnancy, use of oral contraceptives or hormone replacement therapy. 
• Family history of melasma or other pigmentary disorders 

• Clinical examination

Irregularly shaped flat brown or brownish-grey patches 

Occasionally, your doctor may take a small piece of the skin (biopsy) for examination under the microscope to rule out other similar-looking conditions. Consulting your healthcare provider is important to identify the cause of the skin pigmentation and rule out other causes, such as autoimmune disorders, endocrine disorders, and skin cancer.

 How Is Melasma Treated?
Though no complete cure exists to date, there are some treatment options that can improve melasma and keep it under control.  These strategies focus on: [7-9]

• Reducing the triggers (particularly sun exposure)
• Lightening of the pigment
• Long-term maintenance to prevent relapse.

1. Sun protection

Sun exposure is the greatest triggering and worsening factor in melasma. Sun protection must be continued indefinitely because UV exposure can lead to recurrence of melasma.

Some ways to do this include:

• Seeking shade
• Wearing protective clothing such as wide-brimmed hats and sunglasses 
• Avoiding peak sun exposure hours 

This should include avoiding going outdoors, as well as staying away from windows, since UVA and visible light can penetrate through clouds and window panes.

• Using sunscreen:

• Wear broad-spectrum sunscreen when outside or when close to windows for long periods of time
• Apply sunscreen 20 minutes before sun exposure, and repeat every second hour or after contact with water 
• Use a standard amount of sunscreen (2 mg/cm2)  with a higher sun protection factor (SPF) 
• Re-apply sunscreen on time.
• Recent scientific literature supports the preferential use of tinted formulations. The ingredients of tinted sunscreens include iron oxide and titanium dioxide pigments, which provide effective photoprotection against both UV radiation and visible light.  

2. Lightening of the pigment

• Topical Therapies (for application to the affected area)

Hydroquinone

• Highly effective depigmenting agent 
• Used in supervised courses
• Commonly used as a first-line induction therapy for many patients.

Topical retinoids

• Retinoids stimulate the growth of the skin cells, inhibit the pigment-producing cells, and allow better penetration of other topical therapies. 
• Adapalene, a synthetic retinoid, has been used to treat melasma. 

Combined topical agent

• Triple combination cream (TCC), consisting of hydroquinone, retinoid, and topical steroid, is widely used for melasma treatment.
• These creams combine three types of medications, including fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%, all of which have beneficial properties when combined to treat melasma.

Important points to note:

• Hydroquinone monotherapy and TCC remain the gold standard for melasma treatment.
• Most of these treatments should be avoided in pregnancy as they could harm the baby in the womb. Pregnant women are advised to always use these under medical supervision after consulting an obstetrician.

Other treatment options:

Tranexamic acid (TXA)

• It can be used orally, applied topically, or injected into the affected area [7]. 
• However, TXA carries a thrombogenic risk (increased blood clots). 
• To determine whether this can be safely given to you, your doctor will review your medical history to see whether you have any conditions that already increase your risk of clot formation. 
• Be sure to let your doctor know if you have a history of thrombosis, thrombophilia, if you are currently pregnant or planning a pregnancy, and if you are on any birth control pills.

Chemical peels

• These are applied to the skin and improve melasma by removing the outermost cells of the skin that contain the pigment [9]. 
• Glycolic acid peel is most commonly used

Laser and light treatment 

To be performed by a highly experienced laser operator [9].

3. Long-term maintenance to prevent relapse

• Patient education is important because melasma is chronic and relapse-prone
• Long-term outcomes are dependent on consistent sun protection and regular maintenance therapy (as advised by the doctor)

Can Melasma Be Prevented or Reduced?

While melasma cannot be entirely prevented from happening, it is possible to prevent it from worsening. This can be done by [7-9]:

• Strict sun protection
• Avoiding hormonal medications when possible 
• Avoiding irritant skincare practices, aggressive exfoliation, and unmonitored combination bleaching agents, which could worsen melasma.

Conclusion

Melasma is a common and harmless condition. Management of melasma requires patient-centred care with a combination of medical management, patient education, and psychosocial support. Doing this can help achieve better care and improved quality of life for those dealing with this challenging condition.

Frequently Asked Questions (FAQs)

• Can melasma be cured?

No. Melasma cannot be completely cured. However, there are various treatments and preventive strategies that can help keep it under control.

• Can melasma lead to cancer?

No, melasma and skin cancer are two separate conditions. Be sure to consult your doctor if you notice any unusual, changing, raised, or irregular spots on your skin to rule out more serious and life-threatening conditions such as skin cancer. 

• Is melasma contagious?

No. Melasma is not contagious.

• How do I prevent melasma from worsening?

• Strict sun protection
• Avoiding hormonal medications when possible 
• Avoiding irritant skincare practices, aggressive exfoliation, and unmonitored combination bleaching agents, which could worsen melasma.

References

1. Miao F, Wan J, Zhou Y, Shi Y. Unraveling melasma: From epidermal pigmentation to microenvironmental dysregulation. Biology. 2025 Oct 13;14(10):1402–2. Available from: https://www.mdpi.com/2079-7737/14/10/1402 

2.Syder NC, Elbuluk N. The history of melasma: Its roots and evolution. Dermatological Reviews. 2022 June 6;4(1):5–11. Available from: https://onlinelibrary.wiley.com/doi/10.1002/der2.134

3. Handel AC, Miot LDB, Miot HA. Melasma: A clinical and epidemiological review. Anais Brasileiros de Dermatologia. 2014 Sept ;89(5):771–82. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155956/

4. Zhao L, Fu X, Cheng H. Prevention of melasma during pregnancy: Risk factors and photoprotection-focused strategies. Clinical, Cosmetic and Investigational Dermatology. 2024 Oct;Volume 17:2301–10. Available from: https://www.tandfonline.com/doi/full/10.2147/CCID.S488663#abstract

5. Qu Y, Wang S, Xie H, Meng X, Cui B, Xiao Z. Melasma secondary to drugs: A real-world pharmacovigilance study of the FDA adverse event reporting system (FAERS). BMC Pharmacology and Toxicology. 2025 Mar 31;26(1). Available from: https://link.springer.com/article/10.1186/s40360-025-00912-4

6. R DK, Sood R, Tiwari P. Melasma management: Unveiling recent breakthroughs through literature analysis. Health Sciences Review. 2025 Mar;14:100213. Available from: https://www.sciencedirect.com/science/article/pii/S2772632025000054

7. Basit H, Godse KV, Al Aboud AM. Melasma. PubMed. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2026 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459271/

8. Lyons AB, Trullas C, Kohli I, Hamzavi IH, Lim HW. Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens. J Am Acad Dermatol. 2021;84(5):1393-1397. Available from: https://pubmed.ncbi.nlm.nih.gov/32335182/

9. Jo JY, Chae SJ, Ryu HJ. Update on Melasma Treatments. Ann Dermatol. 2024;36(3):125-134. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC11148313/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published October 26, 2026