What Is Melasma? Causes, Triggers and How It's Treated

Melasma is a skin condition that causes patches and spots, usually on the face, that are darker than the person's natural skin tone.

It is not contagious.

The American Academy of Dermatology (AAD), whose patient guidance this page draws on, traces melasma to pigment: the cells that give skin its color (melanocytes) tend to be more active in melasma, and exactly why that happens is not well understood.

Two things melasma is not: it is not skin cancer, and it is not a sign of skin cancer.

The AAD separates the two by feel and pattern, noting that melasma typically feels flat and appears on both sides of the face.

Saying what a particular patch is belongs to a licensed provider, not to this page.

What follows is what the AAD and the published research say melasma looks like, what sets it off, who gets it and what treatment can honestly achieve.

Melasma follows a recognizable pattern.

It usually appears on both sides of the face, most often on the cheeks, chin, forehead, nose and the skin above the upper lip.

Less often, it develops on the jawline, neck or arms.

The patches are flat, and the AAD notes they do not itch or hurt.

The color varies with the person.

The AAD describes tan, brown and grayish-brown patches and freckle-like spots, and in darker skin tones melasma can look bluish-gray.

Two features come up again and again in that description, and they are the same two the AAD uses to distinguish melasma from skin cancer: the patches typically feel flat, and they typically appear on both sides of the face.

Location matters to the people who have it for a simpler reason, too: these are all sites on the face, which is why melasma is hard to ignore and why questions about covering or fading it come up so often.

The honest starting point is that no one knows exactly.

Researchers have found that melanocytes, the pigment cells, are more active in melasma, but the reason is not well understood.

That makes everything else on the list a possible trigger associated with melasma rather than a proven cause.

The AAD's list of possible triggers:

• Sunlight.
• Pregnancy hormones (estrogen and progesterone).
• Some medications: anti-seizure drugs, birth control pills and photosensitizing drugs, including retinoids.
• Stress, which the AAD itself flags as controversial.
• Tanning beds.
• Thyroid disease.

The hormonal triggers show up in real timing.

Melasma often first appears during pregnancy or when starting birth control pills, and it may fade after delivery or after stopping the pill.

It is common enough during pregnancy that it is sometimes called the "mask of pregnancy."

Sunlight appears twice in the AAD's material: once as a trigger that helps set melasma off, and again as the exposure after which melasma commonly comes back.

Both directions matter when you weigh any treatment.

Melasma is much more common in women than men, but men can develop it.

The AAD's higher-risk groups are women aged 20 to 40, people with medium or dark skin tones, and people with a blood relative who has melasma.

On skin tone, the AAD says melasma is more common in people of Latin, Asian, Black or Native American heritage.

On family history, it cites one study of 324 melasma patients around the globe in which 48% reported having a blood relative with melasma.

How common melasma is overall depends on who is counted and where.

A 2022 systematic review reported prevalence between 8.8% and 40%, depending on the ethnicity of the population and the geographical area, and there is no single agreed prevalence figure for the United States.

Any single national figure you see quoted online is worth checking against the source behind it.

Pregnancy pulls these threads together: hormones are on the trigger list, melasma often first appears during pregnancy, and it is common enough during pregnancy that it is sometimes called the "mask of pregnancy." The darker skin tones that carry higher risk also change how treatment behaves — the AAD warns some melasma treatments can irritate darker skin — a point that comes up again under treatment and provider choice.

No. The AAD states it directly: treatments such as creams can help fade the discoloration, but treatments cannot make melasma go away forever.

It can come back, commonly after unprotected sun exposure — and the AAD notes many people see it darken in summer and fade in winter.

The no-cure rule covers procedures too.

No laser, chemical peel or light treatment cures melasma or removes it permanently.

That is not a flaw in one device or one brand; it is a property of the condition the AAD describes, and it matches how the AAD frames procedures: add-ons to sun protection and topical medication for when those are not enough, not stand-alone fixes.

What treatment aims at instead is fading, and that takes patience.

When you follow a treatment plan, it usually takes 3 to 12 months to see results, and long-standing melasma can take longer.

A plan that promises melasma gone forever, or gone in weeks, is promising more than the AAD's guidance describes: fading, over a timeline measured in months.

There is no one best treatment for melasma.

The AAD says the most effective approach often combines sun protection with medications applied to the skin — and sometimes a procedure.

Sun protection is one half of the combination the AAD calls most effective: a daily broad-spectrum, water-resistant sunscreen of SPF 30 or higher, plus a tinted sunscreen that contains iron oxide, because visible light can worsen melasma, especially in people with darker skin tones.

Indoor tanning devices work against you here too; the AAD says they can worsen melasma and prevent treatment from working.

The prescription topicals dermatologists reach for include hydroquinone, tretinoin plus a mild corticosteroid, and triple combination cream, which mixes tretinoin, a corticosteroid and hydroquinone.

Gentler options include azelaic acid, kojic acid and vitamin C.

One practical note: hydroquinone is no longer available in products you can buy without a prescription in the US.

A large review has ranked these options.

Covering 113 controlled trials with 6,897 participants, it found hydroquinone alone and triple combination cream the most effective and best-studied melasma treatments, while chemical peels and laser- and light-based therapies were equal or inferior to topicals and carried a higher risk of adverse effects.

If you go the non-prescription route first, the AAD advises using a non-prescription melasma product for no longer than 3 to 6 months, and seeing a dermatologist if results are not satisfactory.

Procedures enter when topicals and sun protection are not enough.

The AAD lists chemical peels, microneedling, laser and light treatments and PRP as add-ons for melasma.

Two of that list have guides on this site — chemical peel and microneedling — and how either fits a melasma plan is a question for the provider who examines your skin.

Among laser options, the pico laser has its own guide.

Dermatologists also use tranexamic acid (TXA), usually as a pill taken twice a day or applied to the skin, when other treatments fail.

Cost is usually out of pocket: the AAD says most insurers will not cover melasma treatment because it is not considered medically necessary.

Two facts shape the answer.

The first is that the two treatments a large review found most effective, hydroquinone and triple combination cream, are prescription products, so the treatment conversation often starts with a prescriber.

The second is the AAD's position on procedures: only a board-certified dermatologist should perform the procedures it lists for melasma — chemical peels, microneedling, laser and light treatments and PRP.

That is the AAD's professional recommendation as a dermatology society, not a legal rule.

Skin tone raises the stakes.

The AAD warns that some melasma treatments can irritate darker skin, which can worsen melasma and make it darker, and that results usually take longer in darker skin tones.

A provider who treats melasma regularly should be able to talk through how they adjust for your skin tone before anything touches your face.

When a med spa is where you would have a chemical peel or microneedling done, the AAD's guidance turns into concrete questions: who performs the procedure, what certification that person holds, and how the plan handles pigment risk in your skin.

If those questions get vague answers, the melasma-specific risk is the reason not to shrug them off.

Melasma narrows the "near me" search before it starts.

Because the treatments a large review found most effective are prescription topicals, and the AAD recommends a board-certified dermatologist for melasma procedures, the first question about any practice near you is not distance but who treats you: whether the person performing a peel or a microneedling session holds the certification the AAD describes, and how they plan around pigment risk in your skin tone.

Sun protection is the other vetting test, and it is melasma-specific.

The approach the AAD calls most effective combines sun protection with topical medication and sometimes a procedure, and melasma commonly returns after unprotected sun exposure.

A plan that skips the sun-protection step is missing the piece the AAD combines with everything else, whatever the procedure menu says.

Melasma is one entry in our guide to skin and body concerns, which maps each problem a med spa can treat to the treatments that address it.

A local consultation is where the rest of your questions get answered: who would perform each procedure, what it would cost in that office, and how they treat skin like yours.