Hyperpigmentation: The Whys and Hows of Treating Melasma

One of the most common conditions seen today by skin health practitioners is melasma. Melasma is also one of the most stubborn and toughest-to-treat pigment disorders.

This type of hyperpigmentation presents itself in dense patches, often in a symmetrical pattern.  It is usually seen on the cheeks, forehead, upper lip and chin, and occasionally on other sun-exposed areas, such as the arms and chest.  Melasma is often called chloasma or pregnancy mask when it occurs in pregnant women.

Melasma is more common in women with Fitzpatrick skin types IV-VI because they have more active melanocytes, and 10% of cases do occur in men.

3 Types of Melasma

Centrofacial is the most common, appearing on the forehead, cheeks, upper lip and chin

Malar involving the cheeks and chin

Ramus appear on the lower cheek or jawline,

Melasma can appear both in the epidermal and dermal skin layer. It can also be in both. When melasma appears in the epidermal layer it is easier to treat.

Who gets Melasma?

The cause of melasma is still not fully clear, but many different factors have been implicated in this skin condition.

Genetic factors can play a role in the formation of melasma within certain ethnicities, Asian and Hispanic being more prone to the condition.

In addition to genetics, hormonal activity seems to be the most suggested reasoning for the occurrence of melasma. Pregnancy, contraceptives, hormone replacement therapy or hormone treatments can all be responsible for its onset.

Ingredients that Make a Difference

For some patients, melasma can fade on its own when you stop taking hormones, or through the normal re-balancing of hormones after pregnancy. For others, unfortunately, their melasma is known as persistent and can stay pronounced indefinitely.

A good daily skin care regime with products containing ingredients that help this condition is important. Here are some products that help diminish melasma:

  • Hydroquinone
  • Arbutin
  • Retinoids (Retinol is an effective alternative that is much less irritating and converts into retinoic acid within the skin)
  • Kojic acid
  • L-ascorbic acid (vitamin C)
  • Lactic acid

The use of antioxidants, and calming and soothing agents, can help and prevent inflammation in the skin and therefore reduce the incidence of excess melanin formation.

Self Help Tips for Melasma

#1 Sun protection. The most effective self help for Melasma is the consistent use of sun protection. Although sunscreens & blocks will not prevent Melasma, sun protection will help prevent it from becoming darker. Even short exposures to sun can cause significant darkening.

Sunscreens will chemically absorb UV rays while sun blocks will reflect them. If you have sensitive skin, sun blocks may be your preferred protection. New formulas contain micronized zinc or titanium dioxide do not produce the white film on the skin that sunblocks from the past were known for.  I recommend Tizo to everyone, it is an excellent sunblock.

#2 Avoid overly hot environments when possible. If going to the beach or pool use a hat and stay under an umbrella. A water mister will help keep skin temperatures lower. Love your sauna or hot tub? Get ready to see Melasma worsen or re-emerge. When your body temps rise, your melanin cells turn on! Gym workouts can raise body temperatures and make Melasma worse, as well.

#3 Avoid aggressive exfoliating scrubs or strong acid-containing products as both can create inflammation and worsen pigmentation.

#4 Some birth control pills will cause Melasma. If you suspect this is the case, consult your doctor.


Although melasma is frustrating for both patients and the skin health professionals it can be successfully treated. It is important to note that patients prone to hyperpigmentation and melasma will always be susceptible to recurrence so protect your skin

A combination of home care care products with pigment-inhibiting ingredients and consistent broad-spectrum sun protection will be your part. Add regular professionally applied chemical peels in conjunction with laser and microneedling treatments can immensely improve the appearance of this stubborn condition. Contact The Laser Image Company for a complimentary consultation to learn how to fight melasma.

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