How to Treat Melasma & Uneven Pigmentation

Melasma is a type of hyperpigmentation that can create dark spots or discoloration on the skin. The thing that sets melasma apart from other types of hyperpigmentation is while most other types of hyperpigmentation occur due to UV exposure, melasma can also be triggered by drastic hormonal changes.

What does it look like?

Melasma and hyperpigmentation can show up on any sun exposed skin, but usually occurs on the forehead, cheeks or chin in a symmetrical pattern. 

The skin becomes discolored in flat patches of dark skin. Rosacea occurs in a similar placement, but is usually pinker in hue and looks closer to broken blood vessels, while melasma will look browner in color. 

Why does Melasma happen?

For a long time it was thought that melasma came directly from a change in hormones, but it’s now understood that there are many factors that can bring on melasma including UV exposure, genetics and family history or age. 

You can usually expect hyperpigmentation and melasma to show up in areas of the skin that are directly exposed to sun. Sun exposure is the main factor in melasma surfacing, regardless of other factors and what causes hyperpigmentation.

Melasma is also extremely reactive to estrogen and can occur during pregnancy due to an influx of hormones. It can also occur in those who take oral contraceptives. Melasma due to pregnancy will usually fade in the months after delivery/breastfeeding, but will continue in those taking contraceptives as long as the medication is taken. 

How do you treat it?

Each case of hyperpigmentation is unique, but the good news is that there are many different treatments to help.

Topical treatments.

The most effective topical treatments for hyperpigmentation and melasma include:

  • Vitamin C
  • Retinol
  • Glycolic acid
  • Salicylic acid
  • Kojic acid
  • Hydroquinone (more controversially)

Hydroquinone is considered a bleaching agent, but is the most effective treatment for melasma. It is only used for short-term treatments, as it can have some negative side effects. It has been banned in Europe and a similar ban was proposed in the U.S. due to testing that showed it had carcinogenic properties when used on rats, but there is still further research being done. 

Some other topical treatments that have shown promise are alpha-hydroxy acids, niacinamide (vitamin B3), and antioxidant-rich licorice extract.

Oral treatments

Tranexamic acid has shown a lot of promise in treating melasma, as an oral treatment. It was originally used as a way to help those with heavy menstrual periods, but has proved to be effective fighting the pigmentation of melasma, often showing results within the first month. 

Preventative Measures


The best thing you can do to keep melasma at bay is to find an effective sunscreen to combat UV damage. 

Look for a high quality SPF with zinc oxide and iron oxide and use it daily as a preventative measure. 

If you have melasma or suspect you may have it, check with a dermatologist to be sure and to put together a treatment plan. And in the meantime, slather on the SPF. 

The best treatment plan is one that combines high quality skincare routine, preventative measures (covering up and SPF) with medical treatments,