Melasma: Causes, Triggers and Long-Term Management

What causes melasma

Melasma is caused by overactive pigment cells, but why they become overactive is not fully understood. Several factors work together:

• Sunlight, including visible light and infrared heat — the strongest trigger.
• Hormones: pregnancy (sometimes called "the mask of pregnancy"), oral contraceptives and hormone therapy.
• Genetics: it often runs in families.
• Heat exposure, for example from cooking over a stove.
• Irritating skincare and some scented cosmetics.

Why it keeps coming back

Melasma is a chronic condition. Treatment can fade patches, but the underlying tendency remains, so a single day of strong sun can undo months of progress. Thinking of it as something to manage long-term — like a skin condition rather than a stain to remove — leads to better results and less frustration.

Sun protection for melasma

• Use a broad-spectrum SPF 50 sunscreen with a high PA rating every day.
• Choose a tinted sunscreen containing iron oxides, which also block visible light.
• Reapply every two to three hours outdoors.
• Add a wide-brimmed hat and seek shade; sunscreen alone is rarely enough.

Treatment options

Gentle, consistent treatment works better than aggressive treatment, because irritation and heat can make melasma worse.

• Over the counter: azelaic acid, niacinamide, vitamin C, alpha arbutin, kojic acid and tranexamic acid serums.
• Prescription: a dermatologist may use hydroquinone or a triple-combination cream for limited periods, or oral tranexamic acid in selected patients.
• Procedures: light chemical peels and carefully chosen lasers can help some people, but they can also worsen melasma if done incorrectly.

Avoid steroid creams

Some "fairness" and mixed creams sold for pigmentation contain strong topical steroids. They may lighten patches quickly at first, but long-term use causes thinning skin, acne, visible blood vessels and severe rebound pigmentation. Check labels for ingredients such as clobetasol, betamethasone or mometasone and avoid using them on the face without a doctor's supervision.