Hyperpigmentation is a common skin condition caused by an overproduction of melanocytes, the cells that produce skin pigmentation. There are several different kinds of hyperpigmentation, but melasma is a harder nut to crack when it comes to causes and treatment. In terms of appearance, melasma can be characterized by dark, discolored patches on the face in a symmetrical fashion.
Three common melasma facial patterns include the center of the face (centrofacial), cheekbones (malar), and jawbone (mandibular.) Though rare, it can also appear on the neck and forearms. It isn’t entirely clear what causes melasma. However, it’s associated with sun exposure (especially in the summer months), estrogen and progesterone sensitivity (think pregnancy, birth control pills, hormone therapy, etc.), stress, heredity, race, and anti-seizure medicine.
According to the American Academy of Dermatology, 90 percent of people who develop melasma are women (they’re affected nine more times than men), many of whom form the condition when pregnant, which has been given the term “mask of pregnancy.” Melasma is present in 15% to 50% of pregnant women. The prevalence varies between 1.5% and 33%, depending on the population. Persons of any race can be affected; however, melasma is more common in darker skin types than in lighter skin types, and it is significantly more common in light brown skin types.
While it can be obvious to detect melasma, a dermatologist typically uses a Wood’s lamp — a specific type of light that’s held up to the skin — to detect bacterial and fungal infections, as well as how many layers of the skin melasma has affected. In more severe cases, a biopsy may be performed.
If you’re wondering how to get rid of melasma, several different dermatological procedures help control melasma, though it’s not a 100% treatable condition. However, the best creams for melasma — formulated with hydroquinone, retinol, Retin A, tranexamic acid, niacinamide, vitamin C, and other exfoliating and brightening ingredients — are often the first defense method.
The List
Melasma creams lighten the skin differently, such as reducing melanin production, impeding pigment formation, encouraging cell turnover, or physically removing the dark patches. Topical treatments are the favored choice of many dermatologists because they’re effective yet have minimal side effects. Melasma creams are most effective in treating epidermal melasma, which only affects the skin’s top layer. Common active ingredients include hydroquinone, kojic acid, retinoids, niacinamide, and salicylic acid.
FULL LIST
Carrot & Stick Brightening Spot Treatment, $70
Murad Essential C Day Moisture Broad-Spectrum SPF 30 PA+++, $65
Dermalogica Pure Night, $82
Obagi New Derm Clear, Prescription Only
Dr. Dennis Gross Skincare Dark Spot Sun Defense Broad Spectrum SPF 50, $42
Lancôme Renergie Lift Multi-Action Ultra Firming and Dark Spot Correcting Moisturizer SPF 30, $109
Strivectin Advanced Retinol Intensive Moisturizer, $112
Glytone Dark Spot Corrector, $38
Dr. Barbara Sturm Brightening Face Lotion, $205
Shiseido White Lucent Day Emulsion Broad Spectrum SPF 23, $70
Melina Organics Intimate Skin Brightening Gel, $28.65
Porcelana Dark Spot Corrector Plus Sunscreen, $47.85
Skinfix Correct Correct + Dark Spot Corrector, $60
The Different Types of Melasma
There are four types of pigmentation patterns in melasma:
- Epidermal Melasma: The presence of excess melanin in the superficial layers of skin.
- Dermal Melasma: The presence of melanophages (cells that absorb melanin) throughout the dermis.
- Mixed Melasma: A mix of epidermal and dermal.
- Excess Melanocytes: Present in the skin of dark-skinned individuals.
The Dangers Behind Hydroquinone
While over-the-counter hydroquinone creams typically cap at around 2%, dermatologists sometimes prescribe more potent formulas containing anywhere between 8 and 12%. Though the results are much quicker, stronger strengths should only be used for about three months before morphing into maintenance mode.
Though effective, hydroquinone is somewhat of a controversial ingredient. Studies revealed that it is potentially carcinogenic when ingested by rats, and it’s been banned in Europe for years. While it’s still widely available in the States, a similar ban was suggested in 2006. However, the Food and Drug Administration is still reviewing whether or not hydroquinone is truly skin safe as long-term use can lead to skin irritation and permanent depigmentation, which is why it’s only available in small percentages in over-the-counter creams. As everyone’s skin is different, the most significant safety measure you can take is to conduct a patch test first.
The Best Melasma Creams
BEST OVERALL
Carrot & Stick Brightening Spot Treatment, $70
Carrot & Stick’s Brightening Spot Treatment containts 2 highly effective plant-based compounds combine to correct the look of hyperpigmentation and uneven skin tone.
Formulyst Dark Spot Solutions, $79
While it’s technically not a cream, we wanted to point out that serums can also be effective in lightening dark patches — such as this effective formula. Developed for daily use, Formulyst’s Dark Spots Solution Serum targets the appearance of dark spots and uneven skin tone caused by hyperpigmentation. Formulated with HyWhite – an alpha linolenic acid that helps to lighten the appearance of dark spots and visibly improve the uniformity of the skin colour – and a lightweight molecular Hyaluronic acid – which gives an instantaneous moisture hit – this powerful serum intensely nourishes skin, while visibly improving the tone of the complexion.
Murad Essential C Day Moisture Broad-Spectrum SPF 30 PA+++, $65
Vitamin C helps brighten minor cases of melasma, but the added sun protection keeps dark patches from getting out of hand. Of course, C is also a powerful antioxidant that helps protect against environmental stressors. Lastly, it provides the perfect amount of moisture that all skin types can benefit from.
Dermalogica Pure Night, $82
Formulated with niacinamide, vitamin C, and zinc glycinate, this nourishing night treatment cream works overtime to brighten and deeply hydrate the skin. Pumpkin enzyme improves texture while white bird of paradise seed extract restores the skin’s luminosity. For an extra brightening effect use in conjunction with Dermalogica’s C-12 Pure Bright Serum.
Obagi New Derm Clear, Prescription Only
As it contains a potent 4% hydroquinone, you’re going to need a prescription. It’s a great option for those with stubborn melasma who aren’t responding well to over-the-counter creams. Obagi actually has complete systems to target dark spots as well as aging skin, so speak to your healthcare provider to see which products would be best for you.
Dr. Dennis Gross Skincare Dark Spot Sun Defense Broad Spectrum SPF 50, $42
Three forms of vitamin C and melatonin, vitamin E, and broad-spectrum sunscreen significantly reduce the appearance of dark spots and uneven skin tone while protecting the skin from further damage. SPF 50 is the highest FDA-allowed level of suncare available, and it’s non-comedogenic therefore suitable for all skin types. It also works as a moisturizer, thanks to hyaluronic acid, ceramides, and evening primrose oil.
Lancôme Renergie Lift Multi-Action Ultra Firming and Dark Spot Correcting Moisturizer SPF 30, $109
This melasma cream is an excellent choice for those who are battling age along with dark patches. Hydroquinone-free, glycolic acid is the key ingredient that improves skin texture, reduces wrinkles and pigmentation, lifts, and firms. The addition of an SPF 30 protects the skin from the sun’s damaging rays during the day, and it’s oil-free so it won’t clog pores.
Strivectin Advanced Retinol Intensive Moisturizer, $112
Sure, this is an anti-aging cream — but retinol stimulates cell turnover and inhibits tyrosinase, the enzyme our skin needs to produce melanin, which means it’s an effective option for treating melasma, too. It should be used at night and paired with sunscreen during the day. Never use retinol (over-the-counter or prescription) when pregnant.
Glytone Dark Spot Corrector, $38
Hydroquinone (2%), kojic acid, and glycolic acid work together synergistically to fade dark patches while brightening the skin’s overall appearance. As with other products of this nature, only apply it to the areas you’re trying to treat — not your entire face. The bottle features a dab-on sponge top making it easier to target areas of concern.
Dr. Barbara Sturm Brightening Face Lotion, $205
It’s time you became familiar with cress sprout extracts because they’re known to inhibit melanin production and brighten the complexion. As it also contains ginseng extract and vitamin E, it protects against free radical damage (including sun exposure), making it a good pick for those who live in warmer climates or spend a lot of time in the sun.
Shiseido White Lucent Day Emulsion Broad Spectrum SPF 23, $70
Formulated with Shiseido’s proprietary ReNeura Technology+, this daytime SPF improves the appearance of dark spots and the signs of aging while promoting a vibrant, bright complexion. Additionally, it protects the skin from pollen and air pollutants while providing moisture to lessen the fine lines and dryness.
Melina Organics Intimate Skin Brightening Gel, $28.65
This melasma cream is perfect for those who are wary of using hydroquinone. While it was initially developed for sensitive areas such as your bikini line or underarms, it can be used anywhere where pigmentation is concerned. It’s formulated with alpha-arbutin, gentler glycosylated hydroquinone rather than a more potent concentration. Additionally, it contains green tea extracts, citric acid, lemon essential oil, and other naturally-derived skin lighteners. It’s also highly moisturizing and soothing, so no need to worry about any dryness associated with your treatment.
Porcelana Dark Spot Corrector Plus Sunscreen, $47.85
While most melasma creams are designed to be worn at night, this formula protects your skin during the daytime, thanks to a UVB absorber and antioxidants. However, it also contains hydroquinone to help fade existing dark spots while your skin is protected from future damage. Prefer a P.M. treatment? There’s also a nighttime formula minus the SPF.
Skinfix Correct Correct+ Dark Spot Corrector, $60
This vegan and gluten-free cream (in recyclable packaging to boot) is formulated with 13% strength alpha hydroxy acids to gently exfoliate, .25% Tumeric to minimize the appearance of dark spots, and 2% Kakadu plum to brighten and protect. Not only is it effective in treating melasma, but it also helps with pigmentation related to acne scarring.
Melasma Treatment: The Bottom Line
There are several different kinds of hyperpigmentation, but melasma is a harder nut to crack when it comes to causes and treatment. In terms of appearance, melasma can be characterized by dark, discolored patches on the face in a symmetrical fashion.
Three common melasma facial patterns include the center of the face (centrofacial), cheekbones (malar), and jawbone (mandibular.) Though rare, it can also appear on the neck and forearms. It isn’t entirely clear what causes melasma. However, it’s associated with sun exposure (especially in the summer months), estrogen and progesterone sensitivity (think pregnancy, birth control pills, hormone therapy, etc.), stress, heredity, race, and anti-seizure medicine.
According to the American Academy of Dermatology, 90 percent of people who develop melasma are women (they’re affected nine more times than men), many of whom form the condition when pregnant, which has been given the term “mask of pregnancy.” Melasma creams lighten the skin differently, such as reducing melanin production, impeding pigment formation, encouraging cell turnover, or physically removing the dark patches.
Topical treatments are the favored choice of many dermatologists because they’re effective yet have minimal side effects. Melasma creams are most effective in treating epidermal melasma, which only affects the skin’s top layer. Common active ingredients include hydroquinone, kojic acid, retinoids, and salicylic acid. Though effective, hydroquinone is somewhat of a controversial ingredient. Studies revealed that it is potentially carcinogenic when ingested by rats, and it’s been banned in Europe for years.
While it’s still widely available in the States, a similar ban was suggested in 2006. However, the Food and Drug Administration is still reviewing whether hydroquinone cream for melasma is truly skin safe. Long-term use can lead to skin irritation and permanent depigmentation, which is why it’s only available in small percentages in over-the-counter creams. There are additional ways you can slowly treat melasma, including hormone therapy, reducing stress levels, and tweaking your diet.
FAQs
For some women, melasma disappears on its own — typically when associated with pregnancy or taking birth control pills. On the flip side, some people have melasma for years — or even a lifetime — so regular treatment (and daily sun protection) is needed to control the condition. Otherwise, it will come back. Standard treatment methods include:
Chemical peel for melasma
Microdermabrasion
Dermabrasion
Laser treatments
Dermaplaning
Light-based therapy
Sunscreen (more of a preventative measure than a treatment)
Prescription tretinoin, corticosteroids, or hydroquinone (or a Triple Cream with all three)
Over-the-counter topical creams with a less intense percentage of hydroquinone or other lightening and exfoliating ingredients such as kojic acid, retinol, Retin A, vitamin C.
Rebalance Your Hormones
Suppose you’re looking for an alternative melasma treatment, and you’re female. In that case, it can help rebalance your hormones because melanocytes are triggered by abnormal hormone levels, which often occur before, during, or after pregnancy. It can also be helpful to speak with your doctor about adjusting your birth control. For melasma in men and women not taking birth control or experiencing a pregnancy, a hormonal imbalance can be triggered by stress, poor liver health, and thyroid problems.
Tweak Your Diet
While topical treatments and procedures can be useful, treating melasma from the inside out with a healthy diet is also beneficial. Ingredients and foods to look for include:
– Vitamin C: Sure, C works topically to lighten and brighten the skin when applied topically, but eating brightly colored citrus fruits and vegetables helps promote skin health.
– Hydroquinone: While topical hydroquinone is an effective ingredient in treating melasma, it’s sometimes considered a last result because it can cause permanent skin discoloration if it’s too strong or not used correctly. You can take it internally by consuming berries, pears, wheat products, coffee, and tea.
– Kojic Acid: Love Japanese food? You’re in luck because fermented ingredients such as soy sauce, sake, and rice wine are chock-full of kojic acid.
– Indole 3 Carbinol: This ingredient helps break down estrogen. You can find it in healthy veggies like broccoli, kale, cauliflower, and cabbage.
– DIM (Diindolylmethane): Found in vegetables like cabbage and broccoli, DIM helps regulate hormone levels.
Vitamins for Melasma Treatment: All of the above can be taken as a supplement as well.
Reduce Your Stress Levels
Stress can disrupt your hormonal levels, exasperating melasma. While it’s easier said than done, make a conscious effort to reduce your stress levels through meditation, regular exercise, breathing techniques, monitoring your alcohol intake, getting quality sleep, and taking a few moments throughout the day to step outside. Maybe even taking a quick walk around the block.
Sources:
“Melasma: Diagnosis and Treatment,” American Academy of Dermatology Association.
“Melasma,” NCBI, January 2021.
“Hydroquinone,” U.S. Food & Drug Administration Department of Health and Human Services, May 2009.
“OPINION ON deoxyarbutin Tetrahydropyran Yloxy Phenol,” Scientific Committee on Consumer Safety, June 2015.
