Best Treatment for Melasma on Face Recommended by Dermatologist

• Understanding triggers
• Treatment for Melasma
• Systematic Therapy
• Preventing Melasma
• Vitamin C for Melasma
• FAQs

Feeling brown-to-gray patches of discolouration around your skin? It can be Melasma. It’s a form of hyperpigmentation caused by the overproduction of melanin by melanocytes.

It usually appears around the face, such as the cheeks, forehead, nose, bridge, chin, and above the upper lip, and the reason behind it is mostly sunlight exposure and hormonal changes. 

Melasma is also known as the “mask of pregnancy” and is commonly found among women using hormonal contraceptives or hormone replacement therapy. Genetic predisposition is also considered a major factor in melasma on the face.

An essential misconception necessary to address is that melasma is a harmless skin disorder and is not a form of skin cancer. If you’re noticing any such conditions, it’s always advised to consult a dermatologist before considering any medication.

In this blog, we’ll learn about some of the best treatments for melasma on the face. But let's start the discussion with an understanding of the causes of melasma on the face. 

Melasma Causes: Understanding the Triggers Behind Skin Pigmentation

Melasma is like a painter's brush stroke on your skin, resulting in darker regions than the surrounding area. This condition is mostly caused by pigment-producing cells known as melanocytes. These cells go into overdrive, producing more pigment than normal, resulting in the characteristic colouring.

Melasma Symptoms: Recognising the Signs of Skin Discolouration

While the exact cause of melasma is unknown, several factors are thought to contribute:

• Hormones: Hormonal changes, particularly during pregnancy or when using birth control pills, can cause melasma.

• Sun Exposure: UV rays activate melanocytes. Melasma often worsens with sun exposure.

• Genetics: If melasma runs in your family, you may be more likely to develop it.

• Skin Type: People with darker skin tones are more vulnerable.

Melasma and Sun Exposure: How UV Rays Influence Skin Pigmentation

The outer layer of the skin contains cells that contain the pigment melanin. Melanin shields the skin from the sun's UV radiation. These can burn the skin and impair suppleness, causing accelerated ageing. People tan because sunshine stimulates the production of melanin, causing the skin to darken.

Foundational Treatment for Melasma on Face

As we also discussed earlier, if you’re unsure about any skin condition, the first thing you should do is consult a dermatologist. But there are some necessary steps that you must take before and during your treatment for melasma on the face. If you start a treatment like a prescription cream without the foundation, the treatment is likely to fail. In this section, we’ll talk about some of the home remedies for melasma on the face that are crucial, continuous, and non-negotiable in treating and preventing melasma. 

1. The Necessity of Constant Protection

• Rebound Pigmentation: Melasma is highly sensitive to light, and skipping sunscreen even one single day, sometimes even for a few hours, can completely undo months of successful lightening treatment. This rapid return of pigment is known as rebound pigmentation.

• The Chronic Nature: As melasma is a chronic condition, sun protection is a lifelong commitment, not a temporary step. It can be practised 365 days a year, regardless of the weather or your location.

2. Broad-Spectrum Sunscreen (SPF 30)

As skin suffering from melasma is reactive against several chemicals, choosing a better sun protection is the best remedy for melasma. In this section, we’ll talk about some of the products you can consider or prefer.

• UVA and UVB Defense: It’s always recommended to use a broad-spectrum sunscreen such as Clinikally SunProtect Sunscreen SPF 50/PA+++ that protects you against both Ultraviolet A (UVA) and Ultraviolet B (UVB) radiation. UVB rays can cause sunburn and are associated with a higher SPF number. UVA rays often penetrate deeper, contributing significantly to aging, and are often considered as a major trigger for melasma. This protection is indicated by the PA rating (e.g., PA+++).

• Minimum Threshold: Dermatologists recommend using a minimum of SPF 30, though using SPF 50 or higher is maximum defence against this sensitive condition.

3. HEV Light Protection with Tinted Sunscreen

Recent research has confirmed that High-Energy Visible Light, also known as blue light spectrum, is a potent trigger for pigment production, especially in darker skin types prone to melasma. Using standard chemical sunscreens isn’t beneficial against HEVL, as they often fail to block this light.

Dermatologists strongly recommend using sunscreens that rely on physical blockers or mineral filters such as Zinc Oxide and Titanium Dioxide. It just creates a tiny layer on the skin, blocking and reflecting the light.

Additionally, a critical ingredient, Iron Oxide pigment, is also essential to blocking HEV light. It provides the tint in mineral sunscreens. Using a tinted sunscreen that matches your skin tone ensures superior, comprehensive coverage against all major light sources that cause melasma flares.

4. Following a Daily Application Routine

Using sunscreen on all the exposed areas every single day is essential as the best at-home melasma treatment. Even when indoors as UV rays penetrate windows. The chemicals and filters in your sunscreen degrade over time and from contact with sweat or water. Reapplication is also necessary every two hours when spending time outdoors, especially after a swimming session or if you’re perspiring heavily. If you’re using any beauty product or any skincare routine, it’s also suggested to apply sunscreen after makeup.

Medical Treatments for Melasma on Face

Of course! Based on your conditions and severity, a dermatologist suggests a variety of medications and skin care procedures; thus, it’s always important to consult one before taking any medicine. The management of melasma is rarely achieved with a single product or procedure. Thus, a multifaceted, rotational treatment strategy is considered the best treatment for melasma on the face. The results are the best when the treatment is customised to your particular skin type, the depth of pigmentation and your lifestyle.

The fundamental goal of the treatment is to disrupt the melanin production process, accelerate the shedding of existing pigmented cells, and prevent new pigment formation by controlling its primary triggers, such as light, heat, and hormones.

Pharmacological and Topical Therapies

There are a variety of treatments available to fade existing melasma patches that rely on prescription and high-potency topical agents designed to interfere directly with the process of melanogenesis (melanin creation). Let’s have a look at a few:

1. First-Line Prescription Agents

The initial phase of treatment for melasma on the face focuses on powerful agents that act directly and rapidly on hyperpigmentation, and are always used under strict dermatological guidance due to their potency.

Hydroquinone: It’s chemically a phenolic compound that acts as a powerful depigmenting agent. The primary function of these agents is to inhibit the enzyme Tyrosinase, responsible for promoting the conversion of the amino acid tyrosine into melanin. Hydroquinone-containing products block this enzyme and effectively interrupt the melanin production line. Additionally, it slightly damages the cell membranes of the overactive melanocytes, reducing the number of pigment-producing cells. Let’s also have a look at its application and some common concerns:

• It’s commonly prescribed in 4% concentration and typically used in cycles for a few months.

• If you’re pregnant, breastfeeding, or planning a pregnancy, it’s always recommended to consult a doctor, as it has some side effects. Additionally, you can read this guide about how to prevent Melasma during pregnancy.

• Long-term usage of this medication can cause permanent, irreversible blue-black darkening of the skin and temporary irritation and redness. 

The Triple Combination Cream: It’s one of the most effective topical formulations available, and is considered the best cream for melasma and hyperpigmentation. It combines three active ingredients to attack melasma from multiple angles. It’s comparatively more effective than monotherapy because of its effective components. Some of the top products available include Melacare Cream, Triglow Cream, Clearz Max Cream, etc. But, if you’re pregnant, planning birth, or breastfeeding, it’s important to consult a doctor before using this medication. Let’s have a quick look.

• Hydroquinone to block new pigment production.

• Tretinoin, a Vitamin A derivative that accelerates skin cell turnover, leading to rapid exfoliation, causing the superficial, pigmented skin cells to be shed more quickly, accelerating the fading process.

• Low-Potency Corticosteroids such as Fluocinolone Acetonide are used to minimise the irritation, redness, and inflammation typically caused by the hydroquinone and tretinoin, improving patient adherence to the treatment throughout.

2. Alternative and Maintenance Topical Agents

These non-hydroquinone agents are essential for patients who cannot tolerate it, especially breastfeeding and pregnant women. It’s also used during the “off-cycle” maintenance periods to prevent relapse.

• Azelaic Acid: It’s a naturally occurring dicarboxylic acid, offering dual-action benefits. It's a highly effective tyrosine inhibitor and possesses potent anti-inflammatory and antioxidant properties. Azelaic Acid is considered one of the best treatments for melasma on the face for sensitive or acne-prone skin and is considered safe in 15% to 20% concentrations.

• Kojic Acid: It’s derived from fungal species and widely used in melasma removal creams. Kojic Acid works by efficiently chelating copper, a vital cofactor required for the tyrosinase enzyme to synthesise melanin. It binds with copper and effectively shut down the enzyme’s function.

• Cysteamine Cream: It’s a powerful antioxidant and potent depigmenting molecule naturally present in the body. It acts through multiple pathways, including the reduction of tyrosinase activity and the conversion of melanin precursors to lighter substances. Though its usage is often limited due to its distinct sulfur-like odour.

• Tranexamic Acid (TXA) Serums: TXA serums are the best product for melasma on the face. When applied topically interrupts the cascade of inflammation that triggers melanocyte activation following UV or heat exposure. It works by inhibiting plasmin, an enzyme activated by UV radiation that leads to the release of pigment-stimulating factors.

• Alpha-Arbutin: It's a very effective and popular skin-brightening ingredient valued highly in skincare for its ability to correct hyperpigmentation and create a more even skin tone. Alpha-Arbutin products, such as Viso Fer 2% Alpha Arbutin Face Serum, Pilgrim Alpha Arbutin & Vitamin C Brightening Serum, etc., work primarily as a tyrosinase inhibitor that produces melanin (the skin’s pigment). It slows down excessive production of melanin, fading various dark spots, including age spots, sun spots, melasma, and Post-Inflammatory Hyperpigmentation, like acne scars. It’s typically found in water-based serums, and it’s always recommended to be followed by a broad-spectrum sunscreen during the day to prevent new dark spots from forming.

Advanced Procedures and Systemic Therapy

When topical treatments such as Triple Combination Cream fail to achieve sufficient clearance, or when the pigmentation is categorised as deep dermal melasma, dermatologists turn to in-office procedures and oral medications.

1. Specialised Treatments for Resistant Melasma

These procedures are used to physically or chemically remove excess pigment and must be executed by a professional experienced in treating melasma, as any resulting inflammation can lead to post-inflammatory hyperpigmentation and worsen the condition. 

• Chemical Peels (Controlled Exfoliation): It’s a chemical procedure that uses a low concentration of Salicylic Acid, Glycolic Acid, and Lactic Acid, applied carefully. The acid solution causes controlled trauma to the skin, leading to exfoliation and subsequent removal of the top layers of the skin that contain the accumulated excess melanin. For melasma, superficial and mild-to-medium depth peels are generally preferred. Deep peels are often avoided due to the heightened risk of post-inflammatory hypertension in individuals with a predisposition to pigmentation. Multiple, sequential light peels are often safer and more effective than a single, aggressive peel.

• Energy-Based Devices (Lasers and Light): There are a variety of laser treatments available such as Q-Switched and Pico-second lasers that represent the current gold standard for laser treatment of melasma on face. These advanced devices use extremely short bursts of energy (nanoseconds or picoseconds) at very low power to shatter the melanin pigment into tiny fragments. They’re safely absorbed and cleared by the body’s immune system. A common myth of using Intense Pulsed Light (IPL) treatments for melasma on the face is often considered controversial. Though it's widely used for sunspots and generalized redness, its heat and broad spectrum of light can easily trigger the melanocytes, leading to a severe worsening of the melasma.

• Microneedling and Mesotherapy: Microneedling or collagen induction therapy creates thousands of microscopic channels in the skin. This process not only breaks up superficial pigment but enhances the transdermal delivery of topical lightening agents (such as Vitamin C or Tranexamic acid serums) deeper into the skin, where it can be more effective.

2. Oral Medication for Melasma on face

There are a variety of oral medications, such as m-laz, Glucell Plus Forte Tablet SR, Triolite Forte Tablet, etc., that are used to treat melasma on the face. The most common ingredient of these medications is Tranexamic Acid. It’s an internal regulator that works by inhibiting the plasmin-mediated inflammatory pathway within the skin’s vasculature. Melasma often has a small, visible blood vessel in the patches, and TXA stabilises these vessels and reduces the inflammatory signals that continually tell melanocytes to produce pigment. It’s always recommended to consult a dermatologist before taking this medication, as it’s a prescription-only medication. TXA is an antifibrinolytic drug that affects blood clotting, and requires the patient to be screened for any history of blood clots, stroke, or other vascular disease. 

As we all know, melasma is a recurring condition, and there’s no permanent cure available, alongside medication and treatment; thus, changes in lifestyle are also important. Let’s discuss some lifestyle changes you can make to avoid melasma on your face.

Preventing Melasma: Strategies for Maintaining Even-Toned Skin

Avoid the sun, tanning beds, LED screens, irritating soaps, and hormone-based birth control methods. If you are out in the sun, wear sunscreen with iron oxides and an SPF of 30-50 every two hours, along with a wide-brimmed hat. These methods may keep your melasma from worsening.

Melasma and Hormonal Changes: Managing Skin Pigmentation During Life Phases

Hormones may contribute to the development of melasma in some individuals. The pregnancy mask is recognized to occur in obstetric patients. The actual mechanism remains unknown. Estrogen, progesterone, and melanocyte-stimulating hormone levels are often elevated during the third trimester of pregnancy, which could be a cause.

Melasma Skincare Routine: Daily Practices for Melasma Prevention

A consistent and targeted skincare program can help you manage melasma, a common skin issue that causes dark patches on the face, while also improving the appearance of your skin. Here are the steps to follow for a skincare routine meant to help with melasma:

• Use Vitamin C: According to research, Vitamin C is an effective antioxidant that can help diminish hyperpigmentation and melasma. You can treat melasma with a Vitamin C serum or face wash, which inhibits melanin formation, reduces the appearance of dark patches, and enhances the skin's general brightness and evenness. However, vitamin C alone does not alleviate melasma symptoms. As a result, it is used in conjunction with other topical creams.

• Use Skin-Lightening Creams: When looking for the finest melasma lightening cream, search for products that contain chemicals that reduce hyperpigmentation effectively. Skin-lightening creams are available as both prescription and over-the-counter medications. Hydroquinone is a potent skin-lightening chemical that works by preventing melanin formation. It is accessible with a prescription and is regarded as the gold standard for treating hyperpigmentation. Consult your dermatologist before beginning hydroquinone, as it requires monitoring to reduce unwanted effects. Other skin-lightening substances include kojic acid, glycolic acid, azelaic acid, and arbutin, which can help lighten the skin by preventing melanin synthesis. These are available in both over-the-counter and prescription strengths. Including a skin-lightening lotion in your skincare routine helps to keep your melasma at bay and from deteriorating. However, it is critical to consult your dermatologist for personalised therapy for your skin. Soaps containing kojic acid, licorice, or arbutin are also effective melasma cleansers. 

• Use Sunscreen: Sun protection is an important component in treating melasma. UV radiation from the sun can increase melanin production and aggravate the appearance of melasma. Using a high-quality sunscreen can help prevent new melanin formation and protect the skin from additional sun exposure. When selecting a sunscreen for melasma, seek a broad-spectrum option with an SPF of 30 or greater. Sunscreens with PA +++ and an IR filter provide higher protection. Consult your dermatologist for sunscreen advice specific to your skin.

• Use Moisturiser: Moisturizing is vital in any skincare routine, particularly when dealing with melasma. Moisturizers not only hydrate the skin, but they also play an important role in reinforcing its protective barrier. A good skin barrier can help keep environmental factors such as pollution, UV radiation, and severe weather from penetrating the skin and producing damage that can exacerbate melasma. Choose a melasma moisturiser that is tailored to your skin type and has soothing, non-irritating ingredients.

Melasma and Sunscreen: The Role of UV Protection in Melasma Prevention

The roles of UV protection in melasma prevention are given below:

1. Prevention of UV-Induced Pigmentation: Melasma is highly sensitive to ultraviolet (UV) radiation from the sun. UV exposure stimulates melanocytes, the skin cells that produce pigment, leading to increased melanin production and worsening of melasma patches. Regular use of sunscreen helps prevent this UV-induced pigmentation.

2. Protection Against Visible Light: Recent studies have shown that not only UV radiation but also visible light, especially blue light, can exacerbate melasma. Sunscreens that provide broad-spectrum protection, including coverage against visible light, are particularly beneficial.

3. Prevention of Melasma Recurrence: Even after successful treatment, melasma can easily recur with minimal sun exposure. Daily application of sunscreen helps maintain the results of treatments and prevents relapse.

Melasma and Vitamin C: Understanding the Benefits for Skin Discolouration

The benefits of skin discolouration of:

• Vitamin C protects the skin from oxidative stress caused by free radicals and UV rays. UV radiation is a major cause of melasma, so this protection is essential.

• Vitamin C inhibits the enzyme tyrosinase, which is necessary for melanin synthesis. By inhibiting this enzyme, Vitamin C can help reduce melanin production, resulting in a lighter and more even complexion.

• Melasma is linked to inflammation, and Vitamin C's anti-inflammatory properties can help soothe the skin and reduce the redness and swelling that accompany the condition.

• Vitamin C stimulates collagen production, thereby improving skin texture and elasticity. While this does not directly treat melasma, healthier skin can help improve your overall complexion.

• Regular Vitamin C use can help to brighten the skin and reduce the appearance of dark spots and patches. This brightening effect may make melasma less noticeable over time.

Final Thought: Your First Step When You Suspect Melasma

If you’re expecting any symptoms of melasma and are confused about what to do. The first thing you’ve to do is to consult a dermatologist. Avoiding or delaying consultation often leads to worsening the symptoms and increasing the period of recovery as well.

The hyperpigmentation of melasma can easily be confused with various skin conditions or issues, such as Post-Inflammatory Hyperpigmentation (PIH), sunspots, or even birthmarks. Treating other conditions with melasma medications might not work, and thus, dermatologists use tools like Wood Lamps to accurately determine the depth of the pigment to prescribe the correct combination therapy or medication.

Several over-the-counter products are too weak to treat true melasma, and using aggressive home remedies or high-percentage unprescribed acids can cause severe irritation, leading to dreaded rebound pigmentation and worsening the overall condition.

 If you’re taking medication, prioritizing a healthy lifestyle and a better skin care routine can help you manage your melasma, and reduce side effects. By prioritizing professional diagnosis, immediately adopting relentless sun protection, and maintaining open communication with your skin specialist, you gain control over melasma and improve your chances of achieving long-term clarity and confidence.

We wish you healthy and glowing skin!!