Melasma: Diagnosis and treatment
If you notice uneven color on your face, seeing a dermatologist can help
Your dermatologist can tell you whether you have melasma or another condition and what may help you see clearer skin.
How do dermatologists diagnose melasma?
A dermatologist can often diagnose melasma by looking closely at your face and neck.
To get a close-up look, your dermatologist may use a specialized device like a Wood’s lamp or dermatoscope. Placed on (or near) your skin, these devices help your dermatologist see how deeply the darker pigment reaches into the layers of your skin. This knowledge is extremely helpful if you want to treat melasma.
Sometimes melasma can look like another skin condition. To rule this out, your dermatologist may perform a skin biopsy, which involves removing a small bit of skin. Your dermatologist can safely and quickly perform a skin biopsy during your office visit.
Melasma can affect how you feel about yourself
To find out how melasma affects your life, your dermatologist may ask questions or give you a questionnaire.
How do dermatologists treat melasma?
Melasma may go away on its own. This usually happens when a trigger, such as pregnancy or a medication, causes melasma. When you deliver your baby or stop taking the medication, melasma can fade.
Melasma can also last for years, or even a lifetime. While melasma cannot harm your body, it’s understandable that many people want to treat it.
There is no one best treatment for melasma
Often, the most effective treatment combines sun protection with medications that you apply to your skin — and sometimes a procedure.
If you want to treat melasma, be sure to ask your dermatologist about the cost of treatment. As treatment for melasma is not considered medically necessary, most insurers will not cover the cost.
If you decide to treat melasma, your dermatologist will create a treatment plan tailored to your needs. This means your plan will consider your skin tone, how deeply the melasma reaches into your skin, and any melasma triggers you may have. Sunlight, taking birth control pills, and even stress can trigger melasma.
The goals of treatment are to:
Decrease how much pigment your body makes.
Even out your skin tone, restoring it to your natural color.
To achieve these goals, a treatment plan often consists of:
Sun protection: Sunlight causes the skin to make more pigment, which can darken existing melasma and cause new patches.
Your dermatologist will tell you how to protect your skin from the sun. This often involves wearing a wide-brimmed hat while outdoors, seeking shade, and applying a broad-spectrum sunscreen (SPF 30 or higher) throughout the day.
For patients who have melasma, dermatologists often recommend using a sunscreen that contains:
Zinc oxide
Titanium dioxide
Iron oxide
Sun protection can help fade melasma and prevent it from returning
If you’re tempted to skip the sunscreen because it leaves a white cast on your skin, consider using a tinted sunscreen.
Medication and procedures: Your dermatologist may prescribe a medication that can decrease the excess pigment in your skin. Most patients receive a prescription for medication that they apply to their skin at home.
Your dermatologist may prescribe one or more of the following:
Hydroquinone: This is a common treatment for melasma. It is applied to the skin and works to even out the skin tone. Hydroquinone is no longer available in products that you can buy without a prescription.
Tretinoin and a mild corticosteroid: This combination contains a retinoid and an anti-inflammatory, which can even out skin tone.
Triple combination cream: This cream contains three medications — tretinoin (a retinoid), a corticosteroid to reduce inflammation, and hydroquinone to even out your skin tone.
Other medications: Your dermatologist may prescribe a medication that’s gentler on your skin like azelaic acid, kojic acid, or vitamin C.
When using makeup to hide melasma, it’s important to apply everything in the right order to get the best results. Here’s the order that dermatologists recommend:
Melasma medication
Sunscreen
Camouflage makeup
It takes time to see results from treatment, so your dermatologist may recommend using camouflage makeup until your melasma fades
If you haven’t used camouflage makeup before, your dermatologist can give you tips for getting natural-looking results.
Even when you follow your treatment plan, melasma can be stubborn. Some people still see melasma. Researchers have been studying this problem, which has led to several treatment advances.
To improve your results, your dermatologist may add one or more of the following to your treatment plan:
Chemical peel: During this procedure, your dermatologist applies a chemical solution to the melasma. This can help remove excess pigment.
Microneedling: This minimally invasive procedure creates microscopic tears in your skin. As the skin heals, it tends to have a more even skin tone.
Laser and light treatments: A few studies have found that adding a laser or light treatment can improve results for patients who are already applying medication to their skin and protecting their skin from the sun.
Platelet-rich plasma: This procedure involves taking a small amount of your blood, placing the blood into a machine that separates the blood into layers, and then injecting the layer of blood known as plasma into the skin with melasma. This can help even your skin tone.
Only a board-certified dermatologist should perform the above procedures. Getting the desired results requires in-depth knowledge of the skin. A board-certified dermatologist has the training required to select the right procedure for each patient, counsel you on what to expect, and perform the procedure safely.
Are you looking for a dermatologist who focuses on darker skin tones?
Go to Find a Dermatologist, click on Any Practice Focus, and select Skin of Color.
Sometimes, melasma is extremely difficult to treat. When this happens, your dermatologist may talk with you about adding the following medication to your treatment plan:
Tranexamic acid: You may apply this medication to your skin or take it as a pill. In studies, tranexamic acid has been shown to decrease the patches of melasma when other treatments fail to work.
If tranexamic acid is prescribed, it’s usually prescribed as a pill that you take twice a day. Patients prescribed this medication often also use the triple combination cream, sun protection, and makeup that contains iron oxide.
Before prescribing this medication, your dermatologist will talk with you about your health. If you’ve had a blood clot, be sure to tell your dermatologist.
Results take time
When you follow your treatment plan, it usually takes between 3 to 12 months to see results. It may take longer if you’ve had melasma for a long time.
To improve your results, dermatologists often recommend self-care. You’ll find the self-care that dermatologists share with their patients at: Melasma: Self-care.
Images
Images 1, 3-7: Getty Images
Image 2: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
References
Bailey AJM, Li Ho, et al. “Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.” J Am Acad Dermatol. 2021 Apr (article in press).
Bowers J. “Managing melasma: Dermatologists discuss new understandings of the pathogenesis of melasma and emerging treatments.” Dermatol World. 2020;30(1):44-9.
Kim C, Cline A. et al. “Poster 18821: Melasma cost and factors influencing patient satisfaction.” 2020;83(6)suppl. AB222. (no commercial support identified).
Lee HC, Thng TG, et al. “Oral tranexamic acid (TA) in the treatment of melasma: A retrospective analysis.” J Am Acad Dermatol. 2016;75(2):385-92.
Ogbechie-Godec OA, Elbuluk N. “Melasma: An up-to-date comprehensive review.” Dermatol Ther (Heidelb). 2017;7(3):305-18.
Pandya AG, Rivas S, “Melasma.” In: Taylor and Kelly’s Dermatology for Skin of Color. (second edition). McGraw Hill, USA, 2016:356-9.
Sheth VM, Pandya AG. “Melasma: A comprehensive update. Part 2” J Am Acad Dermatol. 2011;65:699-714.
Zhou L. “Poster 18479, Melasma: A systematic review of the systemic treatments.” J Am Acad Dermatol. 2020;83(6)suppl. AB214. (no commercial support identified).
Written by:
Paula Ludmann, MS
Reviewed by:
Arturo Dominquez, MD, FAAD
Ivy Lee, MD, FAAD
Last updated: 2/15/22