Melasma: why dark patches return and how they are treated
You notice brownish patches on your cheeks or above your upper lip. They become more visible in summer and fade a little in winter. Foundation helps, but new “dark spot” products promise quicker results than you see in the mirror. This may be melasma (also called melanoderma), a condition in which skin cells produce excess pigment. Yet not every brown patch on the face is melasma. Before buying an aggressive lightening cream or booking laser treatment, establish what the patches actually are.
Melasma itself is not considered dangerous or contagious. In some people it fades without treatment, for instance after pregnancy; in others it persists for years and flares after sun exposure. A realistic aim is to reduce contrast and maintain improvement. Claims of “permanent removal” misrepresent its fluctuating course. Treatment is optional: sun protection and makeup without active medicines are also reasonable choices.
How to recognise possible melasma and what can resemble it
Melasma usually appears as flat brown, grey-brown or sometimes blue-grey patches with fairly indistinct borders. Common sites are cheeks, forehead, bridge of the nose, chin and the upper-lip area, often in a roughly symmetrical pattern. There is usually no crusting or pain. The same “mask” looks different on lighter and darker skin: some skin tones show more conspicuous borders, while aggressive lightening may leave a further pigment mark.
Similar discolouration can be caused by post-inflammatory hyperpigmentation after acne or irritation, solar lentigines, reactions to cosmetics or medicines, certain inflammatory skin disorders and other conditions. Distribution, previous inflammation and the way the patch changes are clues. A single new patch that changes shape should not be labelled “melasma from a picture”. A rapidly changing, asymmetrical, bleeding, ulcerated, unusually itchy or markedly different lesion needs an in-person dermatology examination to rule out other conditions, including skin cancer.
A dermatologist can often recognise melasma by examining the skin. To investigate details they may use a dermatoscope, a magnifying instrument, or a Wood's lamp, which changes how pigmentation appears; neither makes pigment-depth assessment perfectly precise. Unclear cases may need additional tests and occasionally a biopsy. A home acid test, choosing a “whitener” from a photograph or an app-generated diagnosis is no substitute.
Why patches return even after a good course of treatment
Melasma is associated with increased activity of melanocytes, the cells that produce melanin, the skin's pigment. Sunlight is an important trigger. Visible light also matters, especially in medium and deeper skin tones; ordinary untinted sunscreen may not address that whole exposure. Genetic tendency, pregnancy, some hormonal medicines and skin irritation can also influence the condition. Several triggers may act together in one person.
Not every sun-related patch means a “hormonal imbalance”. Some women first develop melasma during pregnancy; others develop it at other times. A possible link with contraception can sometimes be reviewed with the prescribing clinician, but do not stop a prescribed medicine or contraceptive on your own because of pigmentation. Even after a trigger is removed, patches may persist; a lack of immediate improvement does not automatically mean the diagnosis or advice was wrong.
Persistent irritation is another trap: a product that stings intensely may be mistaken for a more effective product. With melasma, inflammation can cause further darkening. “A stronger peel means faster results” is therefore not necessarily true, particularly for skin prone to post-inflammatory pigmentation.
Everyday protection that helps results last
The most useful habit is consistent light protection, including on cloudy days. Dermatology guidance recommends broad-spectrum sunscreen of SPF 30 or higher and, outdoors, reapplication approximately every two hours and after swimming or heavy sweating, in line with the product instructions. A broad-brimmed hat, shade and sensible limits on direct sunshine add protection that one thin layer of cream cannot supply.
With melasma, a tinted sunscreen containing iron oxides is particularly useful: its pigments help protect against part of the visible-light spectrum. Look for “iron oxides” on the ingredient list rather than relying on the word “tinted” on the front. Choose a shade and texture you can comfortably wear every day. A white cast, stickiness or irritation is a reason to change products, not abandon protection.
Gentle, fragrance-free skincare without intense stinging makes long-term care more manageable. Introducing several acids, scrubs, fragranced serums and prescription-strength products together makes reactions harder to interpret. If something causes persistent burning, pronounced redness or swelling, stop it and discuss the reaction with your doctor. Concealer and foundation are compatible with treatment; makeup does not make your result “less real”.
What treatment options might a dermatologist suggest?
Plans depend on the diagnosis, skin phototype, reactivity, pregnancy, previous procedures and whether you can maintain sun protection. This is an overview of possible approaches, not a reason to choose a procedure. Topical approaches are often more manageable and predictable than trying to erase pigment in one device session; even a well-designed regimen cannot guarantee that all patches will disappear.
| Approach | Possible benefit | Limitation or risk |
|---|---|---|
| Daily SPF, shade, a hat and gentle skincare | Helps prevent worsening and supports other approaches | May not noticeably lighten existing melasma on its own |
| Prescription topical pigment-reducing treatments | Gradual lightening with an appropriate regimen | Irritation and restrictions related to treatment duration, pregnancy and ingredients |
| Combination prescription regimens | Can be more effective than single ingredients for some patients | Need medical supervision; not suitable for indefinite unsupervised use |
| Superficial peels and some device-based treatments | Sometimes help as additions to basic therapy | Uneven lightening, recurrence or post-inflammatory darkening |
| Oral tranexamic acid in carefully selected cases | May improve persistent melasma in studies | Use for melasma is off-label in the US; thrombosis risk and drug interactions need assessment |
A dermatologist may prescribe hydroquinone, azelaic acid or other topical treatments. In certain situations a combination of hydroquinone, tretinoin (a retinoid) and a mild corticosteroid is used; this calls for a defined regimen, not uncontrolled daily use for months. Prolonged inappropriate use of strong lighteners can cause irritation and unwanted changes in skin colour. The US FDA warns that improperly marketed over-the-counter hydroquinone products can cause exogenous ochronosis, an unusual and potentially lasting discolouration. Other countries have different regulatory rules.
Oral tranexamic acid is sometimes considered for stubborn melasma but is not an everyday cosmetic supplement. Before prescribing, a doctor must assess previous blood clots, other risk factors, medicines and particularly combined hormonal contraception. A published expert consensus advises avoiding this approach with current thromboembolic disease, relevant history or elevated risk, and while using combined hormonal contraceptives. A retrospective study in a 2026 journal issue did not detect increased thromboembolic events among selected patients; people with previous thrombosis, coagulation disorders or systemic hormone therapy, among others, had been excluded. This observation cannot establish safety for everyone, particularly anyone with contraindications, and does not remove the need for individual medical risk assessment.
Lasers and light treatments are not an automatic first step. They may sometimes help alongside topical medicines and light protection, but the risks of post-inflammatory darkening and melasma relapse matter. If considering a device procedure, ask not just how it will “remove pigment” but why it suits your skin tone, reactivity and treatment history. Do not accept a guarantee of even skin after one session.
Pregnancy, breastfeeding and plans for a baby
Care during pregnancy is generally more conservative. Melasma first appearing during pregnancy can sometimes fade after delivery. Suitable sun protection and gentle skincare remain the foundation; discuss active medicines and procedures with an obstetrician and dermatologist instead of choosing from online posts. Retinoids, including tretinoin, and hydroquinone should be avoided during pregnancy. Self-prescribing lightening products without clinical advice is not appropriate either.
During breastfeeding, a topical treatment's suitability depends on the exact ingredient, amount of skin treated, skin condition and clinical circumstances. Do not assume that a product permitted outside pregnancy is automatically suitable while nursing. Tell the clinician before starting if you plan to conceive soon: postponing an active regimen and focusing on sun protection may be the better option.
How long until results, and will treatment be noticeable?
Melasma changes slowly. According to the AAD, visible improvement from an individualised plan may take 3–12 months or longer if the patches have been present for years. Even after successful lightening, sunlight and other triggers can make them darker again. Before starting, discuss not only the active course but also maintenance: what to continue every day, when to review progress and what to do if pigment returns.
Topical treatment often does not require time away from work or social plans, but irritation can leave visible redness, dryness or flaking that makeup may not completely hide. Peels can produce more obvious temporary peeling; device treatments may cause redness, swelling, crusts or temporary darkening. Social downtime depends on the exact technique and your skin's response. If a major photograph, seaside holiday or presentation is coming up, avoid a new aggressive treatment without a generous time buffer and a clear recovery plan.
For progress photos, use roughly the same time of day, similar lighting and no colour-changing filter. A patch after a sunny day may look different from the same patch a week later in cloudy weather without any true treatment effect. Following change is useful; examining your skin under magnification every day is not required.
How to choose your next step without unnecessary expense or regret
If patches are mild and you are comfortable with how you look, sun protection and makeup may be enough. If they are new, rapidly changing, unusually shaped or uncertain, diagnosis comes first. If melasma is confirmed and you want to lessen contrast, discuss a gradual topical regimen and relapse prevention with a dermatologist rather than buying the most powerful device session.
At the consultation, ask: “Why is this melasma rather than another type of pigmentation? Is there irritation or another inflammatory component? Which medicines are suitable for me, including if I plan pregnancy? How will we assess results and how long is maintenance needed? What if the patch darkens? What is my risk of post-inflammatory pigmentation?” If tablets are offered, ask about their off-label indication, contraindications and assessment of clotting risk.
Before-and-after photos should use comparable lighting, skin tone presentation, makeup and follow-up interval. Somebody else's impressive picture does not show whether their melasma returned the following season; a review is no substitute for a safety assessment. Detailed comparisons of melasma treatment methods belong after the diagnosis. For your first decision, the useful sequence is to confirm the condition, establish everyday protection, choose a tolerable approach and recognise that managing melasma often needs maintenance, not one permanent procedure.
Frequently asked questions
Can melasma appear only above the upper lip?
Yes, pigmentation can be especially noticeable there, but a single isolated patch may have other causes. If the pattern is unusual or changing, ask a dermatologist to confirm the diagnosis.
Can foundation with SPF replace a separate sunscreen?
Makeup is generally applied too thinly to provide the stated SPF unless you use the tested amount. A dedicated sunscreen first, followed by makeup if desired, is more dependable; tinted sun protection with iron oxides may serve both roles.
Can melasma return after stopping hormonal medicines?
Yes. Even if one possible trigger is removed, sunlight and personal predisposition remain. Do not change hormone therapy on your own; discuss any relationship and alternative with the prescribing clinician.
Sources
- American Academy of Dermatology — Melasma: diagnosis and treatment.
- American Academy of Dermatology — Melasma: self-care.
- American Academy of Dermatology — Melasma: causes.
- American Academy of Dermatology — Skin care during pregnancy.
- U.S. FDA — Safety of OTC skin-lightening products.
- Peer-reviewed expert consensus — Oral tranexamic acid for melasma.
- JAAD International — retrospective oral tranexamic acid and thromboembolism cohort
