Melasma

Overview

Melasma is a long-term kind of discoloration that shows up as matching brown or grey patches on sun-exposed parts of the face. It's far more common in women and in medium-to-deep skin tones, and it often appears or worsens with pregnancy, birth control, or hormone therapy (the so-called "mask of pregnancy"). Unlike ordinary dark marks, melasma is driven by hormones plus both UV and visible light, so it bounces back fast whenever sun protection slips. Think of it as something you manage over time rather than cure: even the best routines need steady, daily sun protection to hold their results.

Evidence anchors

• guideline

  Desai SR, Alexis AF, Elbuluk N, Grimes PE, Weiss J, Hamzavi IH, Taylor SC. Best practices in the treatment of melasma with a focus on patients with skin of color. J Am Acad Dermatol. 2024 Feb;90(2):269-279.

  PMID:37748556View source ↗
• systematic review

  Rajanala S, Maymone MBC, Vashi NA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014 Sep-Oct;89(5):771-82. (Handel AC, Miot LDB, Miot HA.)

  PMID:25184917View source ↗
• systematic review

  Rendon M, Berneburg M, Arellano I, Picardo M. Interventions for melasma (Cochrane Review). Cochrane Database Syst Rev. 2010 Jul 7;(7):CD003583. (Abridged: Jutley GS et al. J Am Acad Dermatol. 2014;70(2):369-373.)

  PMID:20614435View source ↗
• systematic review

  Jutley GS, Rajaratnam R, Halpern J, Salim A, Emmett C. Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review. J Am Acad Dermatol. 2014 Feb;70(2):369-73.

  PMID:24438951View source ↗
• review

  Sheth VM, Pandya AG. Melasma: a comprehensive update — part I. J Am Acad Dermatol. 2011 Oct;65(4):689-697.

  PMID:21920241View source ↗
• review

  Sheth VM, Pandya AG. Melasma: a comprehensive update — part II. J Am Acad Dermatol. 2011 Oct;65(4):699-714.

  PMID:21920242View source ↗
• rct

  Kligman AM, Willis I. A new formula for depigmenting human skin. Arch Dermatol. 1975 Jan;111(1):40-8. (Original 'Kligman formula': 0.1% tretinoin + 5% hydroquinone + 0.1% dexamethasone.)

  PMID:1119822View source ↗
• rct

  Mahmoud BH, Ruvolo E, Hexsel CL, Liu Y, Owen MR, Kollias N, Lim HW, Hamzavi IH. Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol. 2010 Aug;130(8):2092-7.

  PMID:20410914View source ↗
• rct

  Castanedo-Cazares JP, Hernandez-Blanco D, Carlos-Ortega B, Fuentes-Ahumada C, Torres-Álvarez B. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatol Photoimmunol Photomed. 2014 Feb-Apr;30(1):35-42.

  PMID:24313385View source ↗

Ingredients that help

• Hydroquinonestrong

  Fades dark patches by slowing the cells that make pigment and reducing their number. It is the most proven prescription fade ingredient. On its own, 4% works well. The strongest regimen is the Kligman triple combination (4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide), which has the most backing in Cochrane and JAAD best-practice reviews. Use it for about 12 to 16 weeks at a time, then take a break, since long unbroken use can cause a blue-grey staining of the skin.

  PMID:20614435
• Tretinoinstrong

  Speeds up how fast your skin sheds its top cells, so cells full of pigment clear out faster. It is the retinoid part of the Kligman triple combination (the most proven melasma regimen). It also works on its own at 0.05 to 0.1 percent, just more slowly than the triple combination.

  PMID:1119822
• Azelaic Acidstrong

  Fades dark patches by slowing pigment production, and it also calms inflammation. In a 155-person trial, 20% azelaic acid beat 2% hydroquinone (73% had a good-to-excellent response versus 19%), and later head-to-head trials matched it against 4% hydroquinone. It is safe to use in pregnancy, so it is the first topical to reach for when melasma shows up during pregnancy.

  PMID:2528260
• Tranexamic Acidstrong

  Calms the chain reaction that sunlight sets off in your skin to make pigment, so fewer dark patches form. A 2024 analysis of 22 trials (1,280 people) found the oral form gave the biggest improvement in melasma scores. The topical form at 3 to 5% is the safer place to start, and that is what our catalog product gives you.

  PMID:38843906
• Niacinamidestrong

  Stops pigment from being passed into your skin's surface cells, so patches look lighter. In a split-face trial of 27 people, 4% niacinamide gave a good-to-excellent improvement in 44% of cases versus 55% for 4% hydroquinone. It works slightly less well but causes far less irritation. It is a good long-term option once you finish a hydroquinone course.

  PMID:21822427
• Vitamin Cstrong

  Fades patches by slowing pigment production, and as an antioxidant it mops up the sun-driven damage that switches pigment cells on. Clinics often pair it with a mild electric-current treatment (iontophoresis), and it is a standard morning antioxidant to wear under tinted sunscreen.

  PMID:21920242
• Zinc Oxidestrong

  Shields your skin from the full range of UV rays. It is the sunscreen filter the AAD best-practice statement prefers for melasma. On its own, untinted zinc oxide does not block visible light, so it needs iron oxides added to protect against that too.

  PMID:37748556
• Titanium Dioxidestrong

  Shields your skin from UVB and short UVA rays. Most melasma-friendly sunscreens pair it with zinc oxide. Same catch as zinc oxide: it does not block visible light unless the sunscreen is tinted with iron oxides.

  PMID:37748556
• Hexylresorcinolmoderate

  Fades dark patches by slowing pigment production, and it also works as an antioxidant. In split-face studies it matched 2% hydroquinone for facial dark spots including melasma, without hydroquinone's downsides. A good choice if you cannot tolerate hydroquinone or have finished a course of it.

  PMID:21920242
• Alpha Arbutinmoderate

  Fades patches by slowing pigment production. It is a gentler relative of hydroquinone and does not release free hydroquinone into the skin, so it suits long-term upkeep. There is clinical evidence for 2% alpha-arbutin in melasma and in dark marks left after inflammation, especially in Asian and Latin-American skin.

  PMID:21920242
• Kojic Acidmoderate

  Fades patches by slowing pigment production. Most of the evidence comes from Asian skin, where 2% kojic acid combined with glycolic acid and hydroquinone works better than hydroquinone alone. It causes allergic skin reactions more often than the alternatives, so use it carefully on sensitive skin.

  PMID:21920242
• Mulberry Extractmoderate

  Fades patches by slowing pigment production, thanks to natural compounds in white mulberry root (mulberroside and oxyresveratrol). In a placebo-controlled trial, a 75% mulberry extract oil meaningfully lowered melasma scores at 8 weeks (from 4.08 to 2.88), while placebo barely changed.

  PMID:22052272
• N-Acetylglucosaminemoderate

  Fades patches by getting in the way of the cell machinery that makes pigment. The best evidence is for a 2% N-acetylglucosamine plus 4% niacinamide combination, which reduced facial pigment in studies. Think of it as a booster for niacinamide rather than a fade ingredient on its own.

  PMID:21920242
• Licorice Rootmoderate

  Fades patches by slowing pigment production and calming sun-driven inflammation. The effect is modest but real. It is a useful add-on in pregnancy-safe routines where stronger fade ingredients are off the table.

  PMID:21920242
• Glutathionemoderate

  Nudges your skin to make a lighter type of pigment instead of a darker one, and mops up some pigment-triggering damage. The topical evidence is modest and slow. The pill and IV versions are heavily marketed but the studies behind them are weak. Treat it as an add-on, not your main treatment.

  PMID:21920242
• Resveratrolmoderate

  Fades patches by slowing pigment production and quieting the signals that tell your skin to make more pigment. It is often paired with vitamin C in nighttime brightening serums for the upkeep phase of melasma.

  PMID:21920242
• Retinolmoderate

  Helps clear dark patches by speeding up how fast pigment-loaded skin cells shed and by spreading out clumped pigment. It is an over-the-counter retinoid that works like tretinoin but more slowly. A reasonable stand-in for tretinoin when you cannot get a prescription, just slower.

  PMID:21920242
• Polypodium Leucotomosmoderate

  A fern extract you take by mouth that helps protect your skin from sun damage from the inside. The AAD best-practice statement recommends it as an add-on to sunscreen for melasma. It is not a replacement for sunscreen.

  PMID:37748556
• Vitamin Emoderate

  An antioxidant that works alongside vitamin C and ferulic acid to give you longer-lasting sun protection. It is an add-on only. It supports your tinted sunscreen and vitamin C, but it does not fade patches on its own.

  PMID:21920242
• Ferulic Acidmoderate

  Keeps vitamin C and E stable and stretches out their sun-protecting effect, which is why morning serums combine all three. It is an antioxidant booster for melasma, not a fade ingredient on its own.

  PMID:21920242

Suggested routine

Watch out for these on labels

Specific irritants from our watchlist that the research pack identifies as aggravating for melasma.

Products from our catalog

• La Roche-Posay · Anthelios Mineral Tinted SPF 50SPF

  La Roche-Posay Anthelios Mineral Tinted SPF 50. It is the only tinted mineral sunscreen we carry, which makes it the single most important product for melasma. The iron-oxide tint gives you the visible-light protection that plain mineral sunscreens miss.

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• The INKEY List · Tranexamic Acid Night TreatmentTreatment

  The INKEY List Tranexamic Acid Night Treatment. Tranexamic acid is the best-backed non-prescription melasma ingredient we carry. Use it nightly in your brightening serum slot.

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• Naturium · Azelaic Topical Acid 10%Serum

  Naturium Azelaic Topical Acid 10%. Azelaic acid is a pregnancy-safe brightener with strong trial data (Verallo-Rowell, PMID:2528260) showing 20 percent azelaic acid beats 2 percent hydroquinone for melasma. The 10 percent non-prescription strength here is a reasonable place to start.

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• Paula's Choice · C15 Super BoosterSerum

  Paula's Choice C15 Super Booster. Wear this vitamin C antioxidant serum in the morning under your tinted sunscreen. Vitamin C (L-ascorbic acid) is the standard morning melasma antioxidant in the AAD best-practice statement (PMID:37748556).

  View retailer ↗
• The Ordinary · Niacinamide 10% + Zinc 1%Serum

  The Ordinary Niacinamide 10% + Zinc 1%. This is the best-backed pregnancy-safe brightener at the lowest price. Use it year-round to keep patches in check and support your skin barrier.

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• Beauty of Joseon · Glow Replenishing Rice MilkToner

  Beauty of Joseon Glow Replenishing Rice Milk. It pairs alpha arbutin, niacinamide, and rice bran extract in a low-irritation base. A gentle layering step if you have a deeper skin tone and react to stronger actives.

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• La Roche-Posay · Toleriane Hydrating Gentle CleanserCleanser

  La Roche-Posay Toleriane Hydrating Gentle Cleanser. It does not foam, has no fragrance, and helps support your skin barrier with ceramides. This matters for the 'do not aggravate' half of melasma care, since irritation reactivates pigment.

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• CeraVe · PM Facial Moisturizing LotionMoisturizer

  CeraVe PM Facial Moisturizing Lotion. A nighttime moisturizer with ceramides and niacinamide that supports your skin barrier while you are using a retinoid or hydroquinone, with no fragrance and no irritants that react with light.

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Ingredients to consider adding

Not yet in our catalog. Surfaced here as editorial backlog.

• Cysteamine

  Fades dark patches and works without hydroquinone, with growing trial evidence. A 5% cream (Cyspera) beat placebo in a double-blind trial (50 people, 4 months) and matched hydroquinone in a head-to-head 16-week trial. A 2024 review of 7 trials found it meaningfully lightened melasma. It is the strongest non-prescription stand-in for prescription hydroquinone.

• Thiamidol

  Fades dark patches by strongly slowing the enzyme your skin uses to make pigment. It was picked from over 50,000 compounds as the most powerful blocker of that enzyme found so far. At 0.2 percent it matched 4 percent hydroquinone for melasma in a 90-day trial where the assessors did not know which product was which. It is the active in the Eucerin Anti-Pigment range.

• MethimazoleRx only

  A thyroid medication used on the skin to fade dark patches. It blocks a different pigment-making step than most fade ingredients do. At 5 percent it improved melasma in trials without changing thyroid blood levels, which makes it an option if hydroquinone has not worked for you or you cannot tolerate it. In most places it has to be mixed to order by a compounding pharmacy.

• Iron Oxides

  The tint in tinted sunscreen that blocks visible light. Without it, sunscreen does not protect you from the blue and violet light that sets off melasma and keeps it going. In a 2014 trial of 68 people, tinted sunscreen with iron oxides clearly beat plain UV-only sunscreen for melasma over the summer. This is the point most general dark-spot advice skips.

• Fluocinolone Acetonide (low-potency steroid)Rx only

  A mild steroid that is the third part of the Kligman triple combination (Tri-Luma in the US is 0.01 percent fluocinolone, 4 percent hydroquinone, and 0.05 percent tretinoin). It calms the inflammation that drives pigment. Use it for short courses only. Over time, steroids on facial skin can thin the skin and bring out tiny visible blood vessels. It is prescription only.