What Is the Best Treatment for Melasma?

Melasma treatments include over-the-counter skincare products that brighten or exfoliate and prescription medications such as topical hydroquinone. It is important to remember, however, that melasma, a condition that causes dark or uneven patches on the face and other areas of the skin, isn't harmful. Thus, there's no medical reason to treat it unless it bothers you.

If you do choose to treat your melasma, it can be a slow and difficult process. Avoiding triggers is usually the best way to deal with the condition.

This article discusses melasma treatment at home, prescription medications, and other therapies that can help fade melasma hyperpigmentation.

Avoiding Triggers

The best way to control melasma is to avoid the things that trigger it. This may mean wearing sunblock and/or discontinuing the use of certain medications or skincare products. Some of the things that can trigger melasma include:

Sun Exposure

Protecting your skin from the sun is incredibly important. Sun exposure is a chief trigger factor for melasma development.

If you're not already using a daily sunscreen product, now is the time to start. Choose a sunscreen with SPF of 30 or higher, and apply it daily. Ideally, you should wear sunscreen 365 days a year, even on cloudy, rainy, or cold days, and even if you don't spend much time outdoors. Just a small amount of sun exposure can darken your melasma.

For those days when you are spending a lot of time outside, reapply sunscreen frequently. Also, consider wearing a hat or spending as much time as possible in the shade.

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Even after treatment works and melasma has faded, you'll need to continue strict sun protection. It is possible for your melasma to completely return after just a few hours in the sun.

To help your skin respond to other forms of treatment you may be using, use sunscreen as part of your daily skincare routine. An added benefit is that you'll also be protecting your skin from photoaging and skin cancer.

Birth Control

Because melasma is related to fluctuations in hormones, it can occur when you start or stop taking hormonal birth control pills. Some people may also develop melasma after they start or stop hormone replacement therapy. 

Products That Irritate Skin

Skincare products that irritate your skin may make your melasma worse. Avoid scented soaps and other products with fragrances. Retinoids and other skincare products that cause increased sun sensitivity may also worsen your melasma.

Other Factors

• Pregnancy. Melasma often appears during pregnancy. When you become pregnant, your body produces more of the hormones estrogen and progesterone. These hormones are believed to trigger melasma in some people.
• Medication. Certain medications can trigger melasma, especially those that make your skin more sensitive to sunlight, such as antibiotics and certain blood pressure medications. Anti-seizure medications are also known to trigger melasma in some people.
• Stress. Stress may also contribute to melasma, though the research is still unclear. Some researchers believe that the stress hormone cortisol may have a relationship with melasma.
• Thyroid disease: The thyroid gland produces certain hormones that can become unbalanced when you have thyroid disease. If this is the cause of your melasma, it may resolve when your thyroid disease is under control. 

Risk Factors

Certain people may be more prone to developing melasma. These include:

• Females between the ages of 20 and 40. Although males can also get melasma, it is more common in females.
  
• People with medium to dark skin tones. It's thought that people with darker skin might be more prone to developing melasma because their skin naturally produces more pigment.
  
• People who have family members with a history of melasma. Melasma probably has genetic causes in some people.
  

Over-the-Counter Treatments

Over-the-counter skincare products and cosmeceuticals that contain brightening or exfoliating ingredients can be of some help if your melasma is minor. You can add these to your daily skincare routine, but be prepared for a wait. Melasma takes a long time to fade; you won't see improvement for several months.

Some helpful ingredients to look for:

• Kojic
• Niacinamide
• Licorice extract
• Vitamin C
• Mandelic acid
• Glycolic acid

Do Home Remedies Help?

In general, home remedies aren't incredibly effective at improving melasma. A few alternative remedies, like turmeric and aloe vera, have shown at least some success at improving melasma. However, there's not enough info to recommend aloe or turmeric as melasma treatments, and conventional treatments work faster and have better results.

Other home remedies may actually make melasma worse. Don't apply things like lemon juice, apple cider vinegar, raw onion, or garlic to your skin. These highly acidic ingredients can irritate your skin, which can lead to darkening of the very spots you're trying to lighten. Lemon also is a photosensitizer, so it makes your skin much more susceptible to sun damage.

Prescription Medications

The darker the melasma is in comparison to your normal skin tone, the more difficult it is to treat. In this case, prescription medication is going to give you better results than OTC options.

Hydroquinone

This was the mainstay of melasma treatment for decades. Hydroquinone is a topical medication that works by breaking down melanin in the skin.

This is a controversial ingredient though, as some question its safety citing potential carcinogenic effects. Other studies have found no link between hydroquinone and cancer in human beings. High-percentage hydroquinone products can cause permanent loss of skin color (hypopigmentation) and in rare cases, darkening and thickening of the skin (ochronosis).

This controversy has led some countries to ban hydroquinone when used as a skin-bleaching agent (although it still can be used in lower percentages in other cosmetic products). The United States Food and Drug Administration briefly considered banning the ingredient in 2006.

The general consensus among dermatologists is that hydroquinone is safe when used appropriately, although you should know that there are some dermatologists who disagree. The ingredient is usually very effective, which is why some people may risk the side effects to use it.

Make sure to discuss any potential side effects you experience if you are using hydroquinone and to never use this substance outside of a healthcare provider's supervision.

Topical Corticosteroids

Topical corticosteroids, also known as steroid creams, are prescribed for many skin issues because they're anti-inflammatory. They also have mild skin lightening effects. For melasma, topical corticosteroids aren't very effective on their own so you'll also be prescribed another topical treatment to be used along with them.

Tretinoin

Tretinoin is better known by brand names like Retin-A and Renova. A derivative of vitamin-A, tretinoin works by speeding up cell turnover, sloughing off old skin cells and stimulating the production of new. Although tretinoin is a powerhouse for improving signs of aging (fine lines and wrinkles, uneven skin tone, age spots, and rough skin) and acne, it's not incredibly effective for melasma when used alone.

However, tretinoin is effective when used long-term as a maintenance cream.

Triple Combination Cream

Sold as the brand Tri-Luma, this medication is a blend of tretinoin, corticosteroid, and hydroquinone. It gives you the benefits of the aforementioned medications in one cream. This treatment does work faster than using any one treatment alone, and it can improve even severe melasma.

Azelaic Acid

Azelaic acid is another skin lightening agent. Like tretinoin, azelaic acid speeds up cell turnover and smooths the skin. It evens out your skin tone, is fairly gentle, and can be used long term. It is often used as an alternative to hydroquinone.

Tranexamic Acid

This drug is not used as often to treat melasma but is becoming more common. Tranexamic acid is an oral medication that inhibits melanin production. It's not an approved melasma treatment and is used off-label. It's not recommended as a first-line treatment for melasma, but may be prescribed in certain situations when other treatments aren't working.

Procedures

There are also in-office procedures that your dermatologist can do to treat melasma. These are good options if topical treatments aren't well working for you, if your melasma is moderate to severe, or if you simply want a jump-start to treatment.

Most professional procedures should be used as an add-on treatment, and not necessarily a solo treatment, for melasma.

The biggest issue with pro procedures used to treat pigmentation problems is that the procedures themselves can trigger hyperpigmentation development. Complexions that are prone to melasma are also very prone to hyperpigmentation caused by these treatments, so it becomes a catch-22.

Your dermatologist will let you know if any of these procedures are a good treatment choice for you:

• Microdermabrasion
• Chemical peels
• Light and laser treatments

Treatment Tips During Pregnancy

For melasma that develops during pregnancy, there is some good news. This type of melasma often fades away, with some completely disappearing within a year or so after giving birth. Even if it doesn't disappear, it generally fades considerably.

If you're currently pregnant, your healthcare provider will likely take a wait-and-see approach before trying any type of treatment. Many of the medications used to treat melasma are not safe to use during pregnancy.

Wait a few months after delivery, and if it hasn't faded to your liking by then you may choose to start treatment. Until then, keep using sunscreen throughout your pregnancy and beyond to limit melasma development.

Do Melasma Treatments Really Work?

Treatment for melasma can be challenging. Fading of hyperpigmentation takes a long time and may not be complete. There can be some trial and error involved in finding a treatment that works for you, and it's fairly common for the pigmentation to return even after treatment.

In some cases, it's more realistic to think more in terms of lightening and fading the discolorations rather than completely erasing them. With consistent, long-term use of treatment, it is possible to achieve considerable improvement of melasma.

Even without treatment, melasma will often fade over time, especially if you take care to avoid triggers such as sunlight. It is also possible for the condition to resolve on its own or to be unusually responsive to treatment. Sometimes, however, melasma is a permanent condition. 

Summary

Melasma is a condition that causes dark patches to appear on the skin. It is believed to be triggered by factors such as hormones, sun exposure, irritating skin products, and certain medications. There may also be a genetic component.

Melasma is difficult to treat and may take a long time to clear up. Certain medications and treatments can help fade melasma, and in some cases it may evenutally disappear on its own.