Is there a cure for melasma?

Melasma is hard to treat. To determine a treatment plan, your healthcare provider will have to first figure out what’s possibly causing the melasma. Is it sunlight? Your birth control? Genetics? Your soap? Too much screen time?

Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months. Most cases of melasma will fade away with time and especially with good protection from sunlight and other sources of light.

Unfortunately, there is no definitive treatment that will automatically make melasma disappear. At this time there is no way to remove dermal pigment.

If you have melasma, be sure to avoid:

  • Hormone treatments, specifically ones that involve estrogen.
  • Birth control, specifically oral contraceptive pills that contain estrogen and progesterone.
  • LED light from your television, laptop, cell phone and tablet.
  • Makeup you find irritating to your skin.
  • Medications that may cause or worsen melasma.
  • Scented soaps.
  • Skin care products that irritate your skin.
  • Tanning beds.
  • Waxing, which can aggravate the melasma.

Do I need to see a dermatologist for melasma?

Yes. A dermatologist will be able to perform treatments that your usual healthcare provider may not be able to.

Can melasma go away on its own?

Yes, it’s possible that your melasma will go away on its own within a few months. However, it is not likely to go away while you’re pregnant or taking hormone contraceptives. Take preventative steps like avoiding sunlight to keep your melasma from getting worse or, if it does fade away, to keep it from coming back. Melasma can return.

How is melasma treated? What medicines help?

The first thing you need to do to treat your melasma is to make sure that it doesn’t get any worse. Do this by avoiding the sun, tanning beds, LED screens, irritating soaps and birth control that includes hormones. If you are exposed to the sun, be sure to wear sunscreen with iron oxides and a SPF of 30-50 applied every two hours, as well as a wide-brimmed hat. These steps may prevent your melasma from getting worse.

The second path to take is topical medications. Topical therapy using tyrosinase inhibitors prevents new pigment formations by stopping the formation of melanin (the dark color). Examples of tyrosinase inhibitors and other types of helpful agents include:

  • Azelaic acid: This cream, lotion or gel is applied twice a day. It’s safe for pregnant women to use.
  • Cysteamine: A small study of 50 people found cysteamine cream to be more effective than a placebo.
  • Hydrocortisone (a topical corticosteroid): Hydrocortisone helps fade the color caused by melasma. It can also lessen the likelihood of dermatitis that may be caused by other agents.
  • Hydroquinone: This medication is applied as a cream or lotion. It goes directly onto the melasma patches at night for two to four months.
  • Methimazole: Methimazole is an antithyroid cream or an oral tablet. It’s known to help melasma that resists hydroquinone.
  • Soybean extract: Soybean extract is thought to reduce the transfer of color from the melanocytes to the skin cells.
  • Topical alpha hydroxyacid: Epidermal pigments can be peeled off. This cream or chemical peel removes surface skin.
  • Tranexamic acid: This is a cream or injection, or an oral medication.
  • Tretinoin: This prescription is a topical retinoid. It’s effective, but can cause dermatitis and should not be used during pregnancy.

The combination of hydroquinone, tretinoin and a moderate topical steroid has had the best effect on melasma.

Other agents that are being studied to improve melasma include:

  • Absorbic acid (vitamin C).
  • Arbutin.
  • Deoxyarbutin.
  • Glutathione.
  • Kojic acid or kojic acid dipalmitate.
  • Licorice extract.
  • Mequinol.
  • Resveratrol.
  • Runicol.
  • Zinc sulfate.

Are there complications/side effects of the medications?

Dermatitis is a side effect of hydroquinone and tretinoin. Azelaic cream, lotion, or gel can sting. Always be on the lookout for any allergic reactions. Report all side effects to your healthcare provider. It might be appropriate for you to use a different medication to avoid the side effects.

Chemical peels and lasers may cause the surface layers of skin to die, cause post-procedure hyperpigmentation, and cause hypertrophic scars. They can be safely used with topical medications, but only by specialists who have experience treating melasma.

How long will it take the medications to take effect?

It depends on the person and the medication used. Melasma can be slow to respond to treatment. The agents listed above rarely eradicate all of the melasma.

Are there any procedures that can help melasma?

A topical treatment isn’t your only option. There are some procedures that your dermatologist can do to improve your melasma.

  • Chemical peel: In this procedure, your dermatologist will put a chemical on your skin that may make it peel. The skin that regenerates should be smoother and more evenly colored.
  • Light-based procedures like intense pulsed light, non-ablative fractionated lasers and low fluence Q-switched lasers.

What do I do if I’m pregnant and have melasma?

Your melasma is likely to go away when you’re no longer pregnant. If it doesn’t, pursue treatment options with your healthcare provider. While pregnant, be careful to only use topical and oral treatments that are approved for pregnant women.

What specialist should I see to help with treatment of melasma?

A dermatologist specializes in skin conditions. They can help you with management and treatment of your melasma.

Does makeup cover up melasma?

Yes, but use cosmetics that include sunscreen and pay attention to any that may aggravate your melasma by irritating your skin.

What vitamins can I take to help with melasma?

Vitamin D helps keep your skin healthy in general. Your healthcare provider might test your vitamin D levels to make sure that you’re getting enough of it from high vitamin D foods such as meat, cereals, oily fish and eggs. You could also take a vitamin D supplement. Start at 2,000 International Units (IU) per day.

Will melasma go away if I go off birth control?

If the hormones in your contraception are the cause of your melasma then, yes, it may go away. Typically it takes about three or more months for the melasma to fade.

Will melasma go away after I give birth? What about after breastfeeding?

Melasma will likely fade within three months after you’re no longer pregnant.

Last reviewed by a Cleveland Clinic medical professional on 07/27/2020.

References

  • Ali, S, Bali S, P S. Hormonal evaluation in females having melasma. Journal of Evolution of Medical and Dental Sciences. 2015;4:13240-13247. Accessed 7/23/20.
  • British Association of Dermatologists. Melasma. Accessed 7/23/20.
  • NIH. U.S. National Library of Medicine. ClinicalTrials.gov. Study of Influence of Blue Light Emitted by Computer/Television Screens on Melasma. Accessed 7/23/20.
  • Merck Manual, Consumer Version. Melasma. Accessed 7/23/2020.
  • Basit H, Godse KV, Al Aboud, AM. StatPearls: Melasma. 1st ed. Treasure Island (FL): StatPearls Publishing; 2020. Accessed 7/23/2020.
  • DermNet NZ. Drug-induced photosensitivity. Accessed 7/23/2020.
  • DermNet NZ. Melasma. Accessed 7/23/2020.
  • American Academy of Dermatology. Melasma. Accessed 7/23/2020.
  • Barsh G. What Controls Variation in Skin Color? PLoS Biol. 2003 Oct;1(1): e27. Accessed 7/23/2020.
  • Health.gov. Food Sources of Vitamin D. Accessed 7/23/20.
  • Institute for Quality and Efficiency in Health Care. How Does Skin Work? Accessed 7/23/2020.

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