As a dermatologist, I’ve spent years helping patients battle all sorts of skin conditions. But there’s something uniquely personal about treating melasma—it’s a fight I know all too well. Melasma, a pigmentary condition that leaves dark patches on the skin, particularly affects women of color with medium skin tones, including those with ancestry from Asia, Latin America and the Middle East. As I learned from firsthand experience, melasma can be persistent, but with the right strategies, you can manage it and feel confident in your skin again.
My Personal Journey with Melasma
I first noticed the signs of melasma creeping onto my own face in my late 40s. It began after I took a birthday trip to Thailand. The combination of UV exposure and oral contraceptives—prescribed to manage my heavy menstrual bleeding—triggered an onset of hyperpigmentation. That’s when my battle with melasma became deeply personal.
I’ve always stressed the importance of sun protection to my patients. But during that Thailand trip, I saw firsthand how powerful a role hormones and UV rays play in melasma. I’ve spent years honing a treatment routine that not only works for me but also benefits many of my patients.
What is Melasma?
Melasma is a chronic condition that shows up as brown or gray patches on the face, especially in areas that get the most sun—like your cheeks, forehead, nose, upper lip and chin. It’s caused by an overproduction of melanin, the pigment responsible for skin color. Unfortunately, we don’t fully understand why some people get melasma while others don’t, but we do know it’s influenced by a mix of factors such as hormonal changes, sun exposure, genetics and even certain medications.
For me, the hormonal component was especially clear. Taking oral contraceptives while being exposed to the sun during my vacation was the perfect storm for melasma. And for many women, pregnancy, birth control and even hormonal therapies like those for menopause can trigger or worsen the condition.
Here, a few steps to start minimizing your melasma:
Step One: Become a Sunscreen Fanatic
There’s no magic solution for melasma, but prevention is key. Since UV radiation plays a huge role in triggering melasma, I’ve made sun protection an essential part of my routine. I wear sunscreen every single day, regardless of the weather or whether I’m indoors or outdoors. Consistency is critical.
For melasma-prone skin, mineral sunscreens are often the best choice because they physically block UV rays rather than absorbing them like chemical sunscreens do. I also look for products with iron oxide, which offers protection against visible light—a lesser-known but significant melasma trigger.
Some of my favorite sunscreens come from all over the world. ISDIN Eryfotona Actinica ($46) from Spain, MISTINE Sunscreen Aqua ($23) from Thailand and Allies of Skin The One Sunscreen Gel ($45) from Singapore are all products I trust to keep my skin protected. From the U.S., I love Supergoop Mattescreen ($40), Cerave Hydrating Mineral Tinted Sunscreen ($16) and Dermablend CC cream ($41). I also often use RoundLab Birch Sun Cushion SPF 50, a Korean brand that gives me broad-spectrum coverage.
Step Two: Incorporate At-Home Solutions
Sunscreen alone isn’t enough to keep melasma in check. I use a combination of home therapies and in-office treatments to manage it throughout the year.
I rely on topical treatments like Cyspera, a cysteamine cream that’s been a game-changer for many of my patients and for me. This sulfur-containing compound helps to inhibit melanin production without some of the harsher side effects that other skin lighteners, like hydroquinone, can cause.
While hydroquinone was once considered the gold standard for treating melasma, I now recommend other options like prescription-strength retinoids like Arazlo, which help with cell turnover and prevent pigment from building up in the skin.
Step Three: Consider Your Hormones
Since hormones played such a big role in my melasma, I also take a different approach during the summer months. To avoid exacerbating the condition, I stop taking oral contraceptives and switch to oral tranexamic acid pills for three months. Tranexamic acid has been shown to reduce melasma by blocking certain pathways in the pigment production process. However, I always advise my patients to consult with their physician, as tranexamic acid carries its own risks—particularly an increased chance of blood clots, which is why it shouldn’t be combined with hormonal birth control.
Step Four: Try In-Office Treatments
While topical treatments and sun protection can make a significant difference, in-office treatments are often necessary to tackle more stubborn cases of melasma. I regularly perform Q-switch laser treatments, which emit specific wavelengths of light that break up excess pigment in the skin. In recent years, I’ve also incorporated radio-frequency microneedling into my regimen. This technique uses tiny needles to penetrate the skin and deliver heat energy, which helps break down melanin and encourages skin renewal.
These technologies are effective, but melasma is tricky—it tends to reoccur if not managed carefully. That’s why I combine these treatments with ongoing sun protection and skincare. I usually recommend a series of treatments spread out over several months for optimal results.
For some patients, chemical peels offer another viable solution. Depending on the severity of the melasma, I may recommend a glycolic acid peel or trichloroacetic acid (TCA) peel to help exfoliate the skin and lighten pigmentation. I’ve had patients see great results, especially when we combine chemical peels with other treatments like lasers.
Step Five: Make Lifestyle Adjustments
Melasma doesn’t just go away after treatment—it requires maintenance. I’ve made lifestyle changes to keep my melasma under control. In addition to daily sunscreen, I limit my sun exposure as much as possible. I’ve become religious about wearing wide-brimmed hats and sunglasses whenever I’m outdoors. These small changes have made a big difference.
I also advise my patients to look for products that contain kojic acid, azelaic acid, vitamin C, or niacinamide. These ingredients have been proven to help brighten the skin and reduce pigmentation. However, melasma is notoriously stubborn, so I always remind them that consistency is key. It’s important to keep up with treatments even after you start seeing improvement.
Melasma is one of the most challenging skin conditions to treat, but it’s not impossible. Everyone’s skin is different, but with the right plan and commitment, you can achieve clearer, more even-toned skin. One thing to remember if you’re dealing with melasma is that you’re not alone—and that there are effective treatments out there. You can get ahead of it and feel confident in your skin once again.
As a dermatologist, I’ve spent years helping patients battle all sorts of skin conditions. But there’s something uniquely personal about treating melasma—it’s a fight I know all too well. Melasma, a pigmentary condition that leaves dark patches on the skin, particularly affects women of color with medium skin tones, including those with ancestry from Asia, Latin America and the Middle East. As I learned from firsthand experience, melasma can be persistent, but with the right strategies, you can manage it and feel confident in your skin again.