This is the one that always makes me cringe when I hear advice on it. There is so much confusion and misinformation about melasma, and it is a stubborn condition that can elicit serious frustration from sufferers. But fear not! It can be tamed.
I want to share with you EVERYTHING I know about melasma. No gatekeeping secrets that I'll only share if you come in and see me, just real talk about a condition that can literally effect how you show up in your daily life practically overnight.
I've broken this down into the questions I typically hear and see, and then given you my honest, educated answers.
Once you've read through this, and if you think you still need help, I am here for you. Find an opening that works for you on my schedule here.
What is melasma?
Melasma is a type of hyperpigmentation that occurs in the skin. Not all hyperpigmentation is melasma, and it is actually one of the less common types.
Who is typically affected by melasma?
Women are affected by melasma nine times more than men are because it is caused by a hormonal change. It is rare in anyone who has not reached puberty, and usually starts between the ages of 20-40.
What does melasma look like?
Melasma looks like irregular darker patches on the face that are symmetrical from one side to the other. They may not be the same exact shape, but if you have it on your left cheek, you will also have it on your right cheek. It can also look almost blurry and like the color is muted and not sharp, because it is deep within the skin, unlike sunspots or liver spots which have clear edges and look like they sit right on top of the skin.
Where does melasma show up?
The most common places they're seen is the areas that are most exposed to the sun, your cheeks, bridge of your nose, forehead, above the lip, and on your chin.
How/why does melasma start?
We have a lot of really good educated theories about the chain reaction that causes melasma, but not an exact road map. There are still a lot of questions about why one person experiences it but someone else with the same circumstances doesn't. Here are the points we have so far:
A hormonal change happens. The most common one is pregnancy (which is why melasma is also known as the pregnancy mask). But other known changes are going on birth control, starting perimenopause, hitting puberty, using medication that changes hormones, or using topical progesterone creams. The current theory is the specific hormone effecting melasma is progesterone because studies of postmenopausal women who experienced melasma show those treated with just estrogen did not show melasma development vs some of those treated with both progesterone & estrogen did. And further, studies are leaning towards information that its not actually the hormone itself causing the reaction, its the development of more receptors that is actually the cause.
Exposure to the sun occurs as a hormonal change is happening. It's thought that exposure to UVA rays cause free radicals which in turn stimulate the melanocytes in skin to produce excess melanin.
There is a stronger correlation (four times as many) between women who have a thyroid disease than those who don't.
Higher reported levels of anxiety and perceived stress in a persons life also correlates with experiencing melasma. (Very interesting since these can also be side effects of a dysfunctional thyroid).
Can melasma be cured or is it permanent?
Melasma can be cured. Melasma can also come back. This all depends on if you have corrected the root cause of the hormone imbalance. Sometimes, especially if the onset was a pregnancy, once you give birth and are finished breastfeeding, your body's hormones will rebalance themselves, your skin will realize it's not under threat, and it will complete the healing/inflammatory process and resolve the melasma by itself.
Sometimes it needs help completing that process. Sometimes your hormone production will need help or the melasma will come back.
What are the do NOTs of treating melasma?
Let's start with treatments that can make melasma worse.
Progesterone creams. Since these can cause melasma, it doesn't really make any sense to work on removing melasma until you're done using these creams.
Lasers/IPL, RF (radiofrequency) & Morpheus8 treatments. These procedures produce heat deep in the dermis, which can trigger melasma, especially if you have a darker skin tone to begin with. It doesn't happen in every case, but it is a well documented situation. Unfortunately it doesn't typically show up quickly, even waiting a few months to show, but it can be a very aggressive reaction.
Deep peels, especially with glycolic and salicylic acids. Deep peels trigger inflammatory responses in the dermis, which can also trigger melasma.
Foods that stimulate the production of progesterone. Beans (especially soy), broccoli, brussel sprouts, cabbage, cauliflower, kale, pumpkin, spinach. While having these once in a while should be fine, if you know you get a lot of one of these, it might be time to cut back.
Using aggressive lightening scrubs. Synthetic hydroquinone is the only ingredient in the US that is legally allowed to be called a lightener. As of 2024 it can no longer be sold over-the-counter, as it has been reported to have serious side effects (rashes, swelling, and ochronosis which is a permanent discoloration of the skin) and has been linked to higher cancer risks in animals. It has been banned completely in the European Union, Japan, and Australia. (Why do we have it in the US? Licorice root, turmeric, and Uva Ursi can't be prescribed friends). Studies have shown that using these creams/scrubs and aggressively rubbing them into the skin correlates to the worsening of melasma.
Using aggressive lightening creams for long periods of time. It addition to needing to use the creams gently, you also can't use them for extended periods of time or you run the risk of developing ochronosis. This one can't be undone. The patches start to look bluish/black or grey/blue, and there is no known treatment. Even preparations with as low as 2% hydroquinone have caused this condition and it can start in as little time as 6 months of regular use.
Unprotected sun exposure. Daily protection against UVA rays that penetrate deep into the dermis is an absolute must otherwise melasma can be stimulated with each unprotected exposure.
What are the most effective ways to treat melasma?
Gentle brightening agents topically. Skin brighteners are anything that change the skin tone that aren't hydroquinone. My favorites are licorice root, turmeric, and Uvi Ursa (AKA bearberry). Licorice root has been shown to be just as strong, and in some studies even stronger than synthetic hydroquinone. (Check out my soap box rant, I mean blog, all about that here.) Turmeric is one of my go-to's for melasma because it is also a strong anti-inflammatory. Bearberry contains the compound arbutin which decreases the enzyme tyrosinase that produces pigment.
Tyrosinase inhibitors internally. Green tea, cranberries, and blueberries are all excellent sources of arbutin. Cinnamon contains cinnamaldehyde which has anti-tyrosinase activity components. Cumin has cumic acid that does the same. Lychee fruit has flavonoids that have been shown to suppress the growth of melanocytes.
Lighter peels, especially lactic. Lactic acid has a large molecule and a higher pH, which limit the damage it can do to lower layers of your skin so there isn't a likelihood of stimulating melasma. It also has a brightening effect on pigment.
Antioxidants topically & internally. Since it seems to be the oxidation that occurs from UVA exposure that's part of the problem, antioxidants are a must for your treatment plan. These scavengers help stop the chain reaction in its tracks. Great sources are green tea, citrus fruits, dark chocolate (yup), berries, and artichokes.
Microcurrent iontophoresis infusion of vitamin C. Those were a lot of big words huh? This is simply saying we use microcurrent with a vitamin C serum, which helps the serum penetrate super deep into the skin, but doesn't have the side effect of causing heat like lasers, IPL, or radiofrequency (i.e. Morpheus8, RF microneedling). This treatment has been shown to help break up the discoloration.
Wearing a physical barrier, broad spectrum sunscreen daily. Titanium dioxide and zinc oxide are your friends. Keep them with you every day, in the range of 15-30 SPF.
Lymphatic supporting massage. If you want to speed up the process of seeing results, its important to support your body's natural detoxification. Supporting the lymphatic system and interstitium with gentle drainage techniques such as facial cupping, Gua Sha massage, and manual lymph drainage will help remove the damaged cells.
Anti-inflammatory ingredients. To help complete the healing process, I include anti-inflammatories in my treatment of melasma. My favorites are turmeric, because of its brightening abilities, and hemp, because of how it works with the nervous system.
Stress and anxiety management. The stress/anxiety cycle means your body thinks its being threatened. Helping to down-regulate your nervous system into rest & digest is an important factor to the healing cycle. I like to incorporate somatic movements into my Gua Sha massage to help release that stress energy from your body and I always have meditations ready on tap to play during your facials.
I hope this helps explain melasma to you. I know from treating clients that this condition can really effect self-esteem. It can be incredibly frustrating to be told by professionals that such and such pretty expensive treatment will work, only to have it make the condition worse.
If you would like your skin looked at and an integrative treatment plan created just for you, including home care recommendations, I would love to see you for an Enlightenment Facial or Radiant Roots Audit. Follow this link to find out more and schedule a time that works for you.
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