Melasma is a chronic skin condition that causes discoloration on the face. It typically appears as brown, tanned, or grayish-blue patches along the upper cheeks, upper lip, forehead, and chin.
The main causes of melasma are hormonal changes and external exposure to UV radiation, which is why the most effective and long-lasting treatments aim to reduce or eliminate these triggers.
Many women experience melasma during pregnancy, and in such cases, the condition usually improves naturally after pregnancy.
In this article, you’ll discover the best treatments in clinics and home remedies for removing dark spots from the skin.
Frequently Asked Questions About Melasma
Method 1: Melasma Treatment with Prescription Medications
1 – Consult your general practitioner. Talk to your general practitioner about any medications for hormonal changes and creams for melasma that you might try before consulting a dermatologist.
Treatment may be considered elective and may not be covered by your insurance. Be sure to inquire about the costs of any treatments and procedures before scheduling an appointment.
2 – Stop taking medications that could be responsible for the issue. Certain medications, such as birth control pills and hormone replacement therapy, can affect your hormones and trigger melasma. Talk to your doctor about discontinuing these medications.
Although pregnancy is the most commonly associated condition with melasma, the occurrence of dark spots is also linked to medications and conditions that affect your hormones.
Oral contraceptives and hormone replacement therapy are the next two most common causes of melasma, after pregnancy. You may stop using or try switching to a different medication to see if your melasma clears up naturally.
3 – Adjust your hormone replacement therapy. Often, it is not possible to stop hormone replacement therapy. Consider why you’re undergoing hormone therapy to determine if you can stop or adjust the dosage.
However, there are ways to adjust your therapy to reduce the likelihood of dark spots appearing on your skin. Consult your doctor before making any changes.
Try taking hormone replacements at night. If you take them in the morning, they will reach their peak potency when the sun is strongest, maximizing the risk of melasma.
Switching your medication to nighttime may help alleviate the issue.
Creams and patches may be less likely to cause melasma than oral forms of treatment.
Ask your doctor to administer the lowest possible dose.
Home Remedy for Removing Dark Spots from the Skin
4 – Ask your doctor for a prescription for hydroquinone cream. Although some treatments containing this ingredient can be purchased over the counter, your dermatologist or general practitioner can prescribe a stronger version that will be more effective in lightening the skin.
Hydroquinone comes in cream, lotion, gel, or liquid form. It works by blocking the natural chemical process in your skin responsible for creating melanin, and since melanin produces dark pigmentation in the skin, the amount of dark pigmentation related to melasma will also be reduced.
Prescription hydroquinone usually has a concentration of 4%. Concentrations higher than 4% are unlikely to be prescribed in the United States and may be dangerous. They can cause ochronosis, a permanent form of skin discoloration.
5 – Talk to your doctor about another skin lightener. While hydroquinone is used as the first-line treatment in many cases, your dermatologist may be willing to prescribe a secondary skin lightener that may help enhance the effect.
Tretinoin and corticosteroids are among the most commonly used secondary treatments. Both are used to accelerate the process of exfoliation and the replacement of skin cells by the body.
Some dermatologists may even prescribe “triple creams,” which contain tretinoin, a corticosteroid, and hydroquinone in their formula.
Other options include azelaic acid or kojic acid, which slow down the production of pigments that darken the skin.
Method 2: Melasma Treatment with Professional Procedures
1 – Get a chemical peel. A chemical peel is a procedure that uses glycolic acid or another similar abrasive chemical to exfoliate the top layer of skin affected by melasma.
The liquid chemical is applied to the skin, creating a mild chemical burn. As the burned layers peel off, they leave behind fresh, melasma-free skin.
However, this will not prevent melasma if you haven’t addressed the underlying hormonal imbalances.
While glycolic acid is one of the most commonly used options, another common option is trichloroacetic acid, which is a compound similar to vinegar.
Peels made with this chemical may be a bit more painful afterward but can be a good option for severe cases of melasma.
2 – Consider microdermabrasion and dermabrasion. During these procedures, the top layer of skin is gradually removed, leaving clean skin free of melasma in its place.
Both dermabrasion and microdermabrasion are medical procedures that essentially “sand” the superficial layer of skin using abrasive materials.
During microdermabrasion, fine crystals are sprayed across the skin. These crystals are abrasive enough to forcefully remove dead skin cells, thus removing the affected skin.
You can typically undergo about five procedures, each spaced two to four weeks apart. You can also opt for maintenance treatments every four to eight weeks.
3 – Be cautious with lasers. While some laser treatments can help remove skin affected by melasma, some may worsen the condition if poorly administered.
Only undergo laser treatments if administered by a licensed professional. Look for a dual restorative or fractional and pulsed laser (Cold Laser) that targets only pigmentation on the skin’s surface.
Fractional laser treatments tend to be expensive and can cost R$1,500 or more. Keep in mind that you will likely need three to six treatments over three to six months.
4 – Try platelet-rich plasma therapy. For this treatment, the plasma that has been enriched to stimulate recovery is injected into the body.
It is an experimental treatment, still not well understood. However, preliminary evidence shows that it may not only be able to treat the spots but also help prevent their recurrence.
Method 3: Over-the-counter Home Treatments for Melasma
1- Protect Your Skin from the Sun
Apply broad-spectrum sunscreen and take other measures to protect your skin from the sun. This can prevent melasma outbreaks and reduce the risk of worsening the current condition.
Apply sunscreen 20 minutes before sun exposure. Look for a sunscreen with SPF 30 or higher, and consider purchasing one with additional ingredients, like zinc, to benefit your skin.
You can also try “doubling” sun protection. Apply a layer of SPF 15 sunscreen under SPF 30 sunscreen for even more protection.
Wear a wide-brimmed hat and large sunglasses to provide additional protection for your face.
If your melasma is particularly severe, you may also want to consider wearing long-sleeved shirts and pants. Try to stay out of direct sunlight as much as possible.
2- Relax
Stress can worsen hormonal imbalances, and if a hormonal imbalance is the cause of your melasma, finding ways to reduce stress can help treat the issue.
If you’re struggling to relax, try techniques like meditation or yoga. If that doesn’t work for you or you don’t enjoy it, simply take more time for activities you love – such as walks in the park, reading, or taking a bubble bath.
3- Hydroquinone Cream
These medicinal ointments lighten the skin, causing melasma outbreaks to fade.
Home remedy for melasma on the face:
Hydroquinone comes in cream, lotion, gel, or liquid form. It works by blocking the natural chemical process in your skin responsible for creating melanin, and since melanin produces dark skin pigmentation, the amount of dark pigmentation related to melasma will also be reduced.
Some hydroquinone creams even contain sunscreen, so if you want to protect your skin while treating melasma, these options provide a comprehensive solution for you.
Over-the-counter hydroquinone creams usually contain 2% or less.
4- Creams Containing Cysteamine
Naturally present in human cells, cysteamine is safe and proven to be effective in treating melasma.
Cysteamine, the natural product of L-cysteine metabolism in the human body, acts as an intrinsic antioxidant and is known for its protective role against ionizing radiation and as an antimutagenic agent.
Cysteamine works by inhibiting melanin synthesis, leading to depigmentation.
5- Creams Containing Kojic Acid or Melaplex
Both ingredients are skin lighteners but tend to be less aggressive and less irritating than hydroquinone.
Home remedy for dark spots on the skin:
These ingredients reduce the production of melanin, which influences skin darkening. As a result, the new skin cells that are being produced will be less dark, making it harder for melasma to take hold.
6- Tretinoin Cream
Home treatment for melasma:
This is a type of vitamin A that increases the rate at which your skin sheds dead cells. This can help melasma spots fade more quickly.
However, keep in mind that this alone may not cure your melasma if the underlying cause has not been corrected. The affected skin will peel off more quickly, but this will have no impact if your new cells are all affected.
7- Paper Mulberry
Natural treatment for melasma:
This plant grows as a small tree or shrub, and while it has many non-medical uses, the extract or products containing the extract can be used both orally and topically to treat melasma, as long as you follow the product’s instructions.
8- Other Alternative Treatments
Home remedy for melasma on the face:
Other ingredients known to help when applied topically include Bearberry, watercress, mandelic acid, lactic acid, lemon peel extract, apple cider vinegar, and vitamin C.
All of these can inhibit pigmentation-producing substances in your skin without completely neutralizing them and causing irritation or light sensitivity.
9- Wait
If your melasma was caused by pregnancy, it will fade after the pregnancy ends. However, it is more likely to occur in subsequent pregnancies.
Cases of spots not caused by pregnancy may last longer and may require more decisive intervention to treat.
Contact:
Clínica de Pele is a traditional and specialized dermatological clinic in Rio de Janeiro for over 60 years, since 1969.
Dr. Szerman has over 20 years of experience and teaches other doctors.
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Clinically reviewed by Kate Holcomb, MD and 22 collaborators
Original title: How to Treat Melasma
