Ask a Derm With Dr. Arash Akhavan: How Do You Treat Melasma?

Woman with melasma looking in the mirror

If you’ve spent years in the sun (or suffered one terrible sunburn), you might have accumulated sun spots, which appear like a smattering of brown spots on the skin. However, if you’re seeing bigger blotches, there’s a good chance you’re contending with a more challenging foe: melasma.

Melasma is a condition that typically appears as brown or gray patches of pigmentation on the skin. Although it can occur anywhere on the body, melasma is most commonly seen on the face. “Melasma can often have sort of a bluish-gray hue to it, in addition to just being light or medium brown,” said Arash Akhavan, MD, a board-certified dermatologist at The Dermatology & Laser Group℠ in New York City. “Melasma will tend to be a little patchier than sunspots. It won't tend [to have a] distinct border — a little blotchy pattern, often on the lips, cheekbones, and the forehead.” 

Each year in the U.S., there are thousands of newly diagnosed cases of melasma — found more often in women than men. Furthermore, the onset of melasma typically presents itself when individuals are in their reproductive years. But why are women more susceptible, and specifically during that time of their life? Where does melasma come from, and how can it be treated? We chatted with Dr. Akhavan to find out more about this hormone-influenced skin condition.

What causes melasma? 

Melasma has a few origins. “It's linked to both ultraviolet light and hormones, specifically estrogen,” says Dr. Akhavan. “It’s much more common in women who have either been on hormonal birth control or have had pregnancies: They've had times in their lives where they had higher estrogen levels.” 

Generally, dark spots are created when melanocytes (the pigment-producing cells in the skin) go into overdrive. These cells are triggered by the melanocyte-stimulating hormone (MSH), a group of hormones produced by the pituitary gland, hypothalamus, and skin cells. However, doctors still aren’t quite sure why melasma occurs beyond the links between skin, UV light, and hormones. 

There could also be a genetic component to this skin concern. Those who have family members with melasma are more likely to develop it, too, and those with darker complexions are more prone to it (as they already have more melanocytes). Beyond that, though, the reasons behind melasma’s development are still unknown.

Is melasma curable?

Unfortunately, there is no cure for melasma. “We can treat it, we can minimize it, but we can't completely prevent it or completely cure it,” says Dr. Akhavan. To help protect yourself against melasma (and minimize current spots), he recommends blocking your exposure to ultraviolet light, especially ultraviolet A, by using a sunscreen that contains zinc with a 10 percent or higher concentration. His favorite brands for these types of sunscreens are MDSolarSciences® and ISDIN®

Why is melasma difficult to treat?

The pigment in melasma is different than other hyperpigmentation conditions. “It’s both superficial and deeper in the skin, so we have a tough time treating it,” he says. ”Melasma is a little trickier to get rid of than other things because the hormones are at play.” 

What are some ways to reduce melasma?

Individuals with melasma can opt for over-the-counter and prescription solutions. One over-the-counter option is PeterThomasRoth® Retinol Fusion PMTM ($65), which uses 1.5 percent retinol to help brighten skin. Other ingredients to seek out include azelaic acid, kojic acid, and vitamin C, which all work to fade dark spots and are available in over-the counter formulations. As far as something stronger, Dr. Akhavan says another option may be speaking with your doctor about a prescription that combines four percent hydroquinone, tretinoin, and a corticosteroid to help target melasma.

Editor's Note

Retinol shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.

What should people with melasma avoid?

Dr. Akhavan suggests avoiding facials that use heat, steam rooms, saunas, and certain lasers, as there is some research that shows that heat makes the condition worse. “Because lasers use heat, you can actually make it look better for a short period of time, but in the long run it may get worse if you're using aggressive settings or if you're using the wrong laser,” said Dr. Akhavan. “The exact right type of laser can be helpful, if it's in very trained hands.” Consult with your provider to see what’s best for your skin’s needs.