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Melasma: patches that come and go with sun and hormones

Clinical name: melasma

Melasma causes brown or grey-brown facial patches that flare with sun and hormones. What helps, what can worsen it, and why it often returns.

Education, not a diagnosis. Only a clinician who examines your skin can say what you have. Every point below shows how strong the evidence is and links to its source.

Who it affects

  • Melasma is reported much more often in women, usually starting in adulthood. Anyone can be affected.[1,2,3,4]Established
  • It is reported more often in people with medium to deep skin tones and in people who tan easily.[1,4,5,6]Supported
  • Sources disagree about the deepest skin tones. Some name Black people among those more affected, while others say melasma is less common in very dark skin. A US health-records study found slightly lower odds in Black patients, but records only count people who were diagnosed.[1,2,3,4]Mixed
  • Reported rates vary hugely between studies, from rare to common, depending on who was studied. Skin tone and background are broad labels, and people within any group differ.[6,7]Supported
  • It often starts in pregnancy or while taking hormonal birth control. In US health records, hormonal contraception was linked with melasma. That is an association, not proof of cause.[3,4,8]Supported
  • Many people with melasma have a relative with it too.[1,4]Supported

What it can look like

  • Brown or grey-brown patches on the face that can darken with sun, often in summer.[4,6,8]Supported
  • Triggers named by dermatology sources include sun and tanning beds, pregnancy, hormonal medicines, medicines that make skin sensitive to light, stress and thyroid disease. Why these matter is not fully understood.[1,5]Thin
  • Other conditions can look similar, including dark marks after inflammation and darkening from long-term lightening cream use. A clinician can tell them apart.[6,9,10]Mechanistic only

What helps

Daily light protection is the foundation

  • Daily broad-spectrum sunscreen all year, including on cloudy days, plus shade and hats, is the base of every melasma plan.[4,5,11]Established
  • Both UV and visible light play a part, and even small amounts of light may trigger melasma.[2,4,6]Supported
  • Dermatology groups in the US, UK and New Zealand recommend tinted sunscreens with iron oxides for melasma, because the tint adds visible-light protection.[4,5,11,12]Established
  • In a trial of 68 people who were also using hydroquinone, a sunscreen that blocked visible light as well as UV led to more improvement than a UV-only one. It was a single center over 8 weeks.[13,14]Supported
  • A later trial reported that a tinted, visible-light-protective sunscreen protected people with melasma better through summer than an untinted one.[15]Thin

Gentle care and cover-up

  • Gentle, non-irritating skin care is advised.[11]Mechanistic only
  • Camouflage makeup is a reasonable choice while you wait for other steps to work.[11]Mechanistic only

Treatments a clinician may discuss

These are options to talk through with a clinician, not instructions for treating yourself.

  • Triple combination cream (hydroquinone, tretinoin and a mild steroid) did better than hydroquinone alone in systematic reviews. It is a prescription product, used with supervision because it contains a steroid.[14,16,17]Supported
  • Hydroquinone works for melasma. It is prescription-only in the UK and New Zealand, not legally sold over the counter in the US, and used in limited courses.[5,17,18,19]Supported
  • Tretinoin, azelaic acid and cysteamine each beat a comparison in trials. Cysteamine did better than a plain cream and showed no clear difference from hydroquinone, with similar irritation. Most trials were small and short.[16,20,21]Supported
  • Niacinamide improved melasma in a small, 8-week split-face trial against hydroquinone, with fewer side effects. The trial was too small to show the two work equally well.[22]Thin

Tranexamic acid

  • Tranexamic acid reduced melasma severity across trials. The largest effect was with tablets, then injections, then creams.[17,23]Supported
  • Oral tranexamic acid is prescription-only. Before considering it, clinicians screen for a history of blood clots, clotting disorders, pregnancy and estrogen-containing birth control.[6,23]Supported
  • Side effects reported in trials included stomach upset and changes to periods. Long-term safety has not been established.[23]Supported
  • In a narrative review, creams and injections worked about as well as hydroquinone, with fewer irritant reactions.[24]Thin

If you are pregnant, trying to conceive or breastfeeding

This page does not suggest any lightening or fading active during this time. Talk to your clinician before starting any pigment treatment.

  • Melasma that starts in pregnancy often fades in the months after delivery, though it can stay or come back.[2,6,8]Supported
  • Sun protection, gentle care and cover-up makeup remain the everyday steps.[2,11]Mechanistic only
  • Oral tranexamic acid is not used in pregnancy.[6]Supported
  • Mercury, found in some illegal lightening creams, is a particular danger for pregnant and nursing people and young children.[25,26]Established

Expect a long game

  • Results usually take 3 to 12 months, and melasma can persist despite treatment.[6,27]Established
  • Melasma is long-lasting and often comes back, especially with sun exposure or after treatment stops. There is no cure, so plans aim for control.[4,5,6,8]Established
  • Long-standing melasma tends to respond more slowly.[4]Mechanistic only

What to avoid

  • Treating a peel, laser or microneedling as a quick fix. Results are mixed, side effects are more common than with creams, and procedures can make melasma worse, especially in people of color.[2,4,5,17]Supported
  • Tanning beds and unprotected sun.[1,5]Supported
  • Irritating products and harsh scrubbing.[11]Mechanistic only
  • Unregulated lightening or whitening creams. Some have been found to contain mercury, hydroquinone or hidden steroids.[26,28]Established
  • Long, unsupervised hydroquinone use. It has been linked to ochronosis, which may be permanent.[9,18,19]Supported
  • Taking tranexamic acid tablets without a clinician. Screening for clot risk comes first.[6]Supported

When to see a clinician

  • You notice patches on your face that come and go with sun or hormones. A clinician can confirm what they are and rule out look-alikes.[6,27]Mechanistic only
  • You are pregnant, trying to conceive or breastfeeding and want to treat pigment.[2,6]Mechanistic only
  • Patches appeared after starting a new medicine, including hormonal medicines or ones that make skin sensitive to light.[1,5]Thin
  • You want to talk through prescription options such as triple combination cream or tranexamic acid.[6,27]Supported
  • Blue-black or grey darkening appears where a lightening cream was used.[9,18]Thin
  • A single spot is new, changing or irregular. That needs a prompt check, not a fading plan.[29]Mechanistic only

Label claims to question

“Tinted or with iron oxides”
Tinted iron-oxide formulas can block visible light, and in melasma trials UV plus visible-light protection did better than UV alone. The label does not say how much visible light is blocked, whether the shade suits your tone, or replace UV protection.[11,13,30]
“SPF 50 or Broad Spectrum”
In the US, SPF measures protection from the rays that cause sunburn, and Broad Spectrum means UVA protection too. Neither tells you about visible light, which matters for melasma.[30,31]
“Blue light or HEV protection”
Signals some intent to address visible light. No standard test or label measure was found for it, so the specific product's performance is unknown.[30,31]
“Hydroquinone-free alternative”
Tells you hydroquinone is not in it. It does not show it works as well or irritates less. Cysteamine has trial data; many alternatives do not.[21,22]
“Clinically proven”
Melasma trials are mostly small and short, and rarely follow people long enough to see relapse. Without the trial details, the phrase cannot tell you how a product performs on your skin or over time.[14,16,17]

Where the evidence is thin

  • Whether melasma is more or less common in people of African descent is disputed. Sources disagree, and health-records data can miss people who were never diagnosed.
  • Prevalence figures are unreliable. Estimates range from rare to very common, the widely repeated pregnancy figure is not sourced on the page that gives it, and figures for South Asian, Middle Eastern and Southeast Asian people were not found in primary studies.
  • Oral tranexamic acid looks reassuring in screened patients, but long-term safety, and safety for anyone with clot risk factors, is unknown. A 2026 records study reporting no link to clots could only be checked by its title.
  • A trial of visible-light sunscreen for preventing relapse exists, but its numbers could not be checked. Some visible-light trials may have industry links.
  • Newer options such as thiamidol are only thinly covered in the sources, and several patient pages date from 2022.

Keep going

Sources

Retrieved and read for this guide; reviewed 2026-09-13. A source listed here says what it establishes and what it does not — a citation is not an endorsement.

  1. [1]Melasma: Causes · American Academy of Dermatology, 2022Establishes: Names who is more affected: women, medium-to-dark skin tones (Latin, Asian, Black and Native American heritage are named), and people with a family history (48% report an affected relative). Listed triggers: sun and tanning beds, pregnancy, hormonal medicines, photosensitising medicines, stress, thyroid disease.Does not establish: That these triggers cause melasma; the page states the mechanism is unclear.
  2. [2]Melasma · Skin of Color Society, 2026Establishes: Melasma mostly affects women (90% is cited) and people of colour, with higher prevalence said to occur in Latin America, Asia, the Middle East and Northern Africa. Even small amounts of light can trigger it. Pregnancy melasma often fades after delivery. Peels, microdermabrasion and lasers give inconsistent results and may worsen it.Does not establish: Country-level prevalence data.
  3. [3]The Burden of Melasma: Race, Ethnicity, and Comorbidities · J Drugs Dermatol 23(8):691–693, 2024Establishes: Retrospective EHR cohort (brief communication). In a TriNetX US-based database of 41,283 melasma patients (93% female), odds of melasma were higher for Asian (OR 2.0), Other/Unknown (1.7) and Hispanic (1.3) patients, and slightly lower for White, Black/African American and non-Hispanic patients (0.8 each). Hormonal contraception (OR 2.1), rosacea and atopic dermatitis were also associated.Does not establish: Causation or true community prevalence. It is correlational, based on ICD-10 coding and people who sought care.
  4. [4]Melasma · DermNet (NZ), 2025Establishes: Melasma mainly affects women aged 20–40 with Fitzpatrick III–IV skin. Hormonal factors, UV and visible light, and family history are involved. Year-round SPF50+ sunscreen with iron oxides is advised. Relapse is common, and peels and lasers can worsen it.Does not establish: Population prevalence figures. The page's statement that melasma is less common in very dark skin is not sourced.
  5. [5]Melasma (Patient Hub leaflet) · British Association of Dermatologists, 2024Establishes: Up to 50% of pregnant women may be affected. Melasma is more common in people of colour and people who tan easily. Triggers: hormones, UV, sunbeds, possibly high-energy visible light. SPF50+ with iron oxide is advised. Hydroquinone is prescription-only with limited-duration use. Lists triple cream, azelaic acid, cysteamine, thiamidol and tranexamic acid. Procedures risk worsening, especially in people of colour. There is no cure and relapse is common.Does not establish: The 50% pregnancy figure, which it does not source, or any efficacy comparison between the treatments it lists.
  6. [6]Melasma (StatPearls) · NCBI Bookshelf (Sathe, Launico), 2026Establishes: Melasma disproportionately affects Fitzpatrick III–V; in the US the burden is higher in Hispanic/Latino and Asian people. Prevalence during pregnancy varies widely between studies. Visible light contributes. Hydroquinone is used in supervised courses. Oral tranexamic acid is contraindicated with thrombosis history, thrombophilia, pregnancy or estrogen contraception. Melasma is chronic and relapsing.Does not establish: Reliable prevalence numbers by ethnicity — it says the data are limited.
  7. [7]Melasma: an Up-to-Date Comprehensive Review · Dermatol Ther (Heidelb), 2017 · read at abstract levelEstablishes: Reported melasma prevalence ranges from 1% to 50% depending on the population studied. It is more common in women and darker skin types. Light, hormones and family history are implicated. Combination therapy tends to outperform single agents.Does not establish: Population-specific prevalence.
  8. [8]Melasma: Overview · American Academy of Dermatology, 2022Establishes: Melasma is most common in women with medium-to-dark skin and often starts in pregnancy or on birth control pills. It may fade afterwards but often persists or returns, especially with sun exposure.Does not establish: Any numbers — it gives none.
  9. [9]Exogenous Ochronosis: Characterizing a Rare Disorder in Skin of Color · J Clin Med 12(13):4341, 2023 · read at abstract levelEstablishes: Retrospective case series with review. In 25 patients with exogenous ochronosis, the average lightening-cream use was 9.2 years. The blue-black pigment appeared mostly on the cheeks, forehead and temples. The condition mainly affects people with skin of colour and is distressing.Does not establish: Risk per user, or any duration or concentration that carries no risk — a case series cannot identify either.
  10. [10]Postinflammatory hyperpigmentation · DermNet (NZ), 2015Establishes: PIH is more intense and longer-lasting in darker skin. Inflammation drives melanin production, with an epidermal form and a dermal (macrophage) form. Physical treatments can worsen PIH by injuring the epidermis.Does not establish: Any trial data or comparative efficacy — it gives none. The page was last updated in December 2015.
  11. [11]Melasma: Self-care · American Academy of Dermatology, 2023Establishes: Advises daily broad-spectrum SPF30+ sunscreen, including on cloudy days. Tinted sunscreen with iron oxide helps block visible light. Also advises gentle, non-irritating skin care and camouflage makeup.Does not establish: How much a tinted sunscreen adds — it does not quantify it.
  12. [12]Sunscreen Selection · Skin of Color Society, 2026Establishes: Mineral filters may leave a white cast on darker skin. Options: tinted shades, thin layers, micronised mineral formulas, or foundation layered on top. Tinted sunscreens with iron oxides protect against visible light and are especially useful for melasma and hyperpigmentation. Use about ½ teaspoon for face and neck and reapply every 2 hours.Does not establish: Any product comparison or white-cast testing.
  13. [13]Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial · Photodermatol Photoimmunol Photomed, 2014 · read at abstract levelEstablishes: 68 melasma patients, all also using 4% hydroquinone for 8 weeks: a UV-plus-visible-light (iron oxide) sunscreen gave greater improvement than a UV-only sunscreen on MASI, colorimetry and melanin.Does not establish: What a tinted sunscreen does on its own — everyone also used hydroquinone. Single-centre and short-term, and it tells us nothing about dark marks after inflammation (PIH).
  14. [14]Self-applied topical interventions for melasma: systematic review and meta-analysis · Br J Dermatol, 2022 · read at abstract levelEstablishes: Across 36 investigator-blinded RCTs, triple combination cream, hydroquinone and tretinoin were effective. Sunscreen covering both visible and UV light improved hydroquinone's effect. Tranexamic acid and cysteamine comparisons were meta-analysed.Does not establish: A definitive ranking. Certainty ranged from very low to high.
  15. [15]Comparison of Visible Light-Protective Tinted Sunscreen to Untinted Sunscreen to Protect Melasma Patients During Summer · J Cosmet Dermatol, 2025 · read at abstract levelEstablishes: Randomised investigator-blinded trial. The abstract reports a tinted visible-light-protective sunscreen protected melasma patients better during summer than an untinted one.Does not establish: Sample size or effect size, which were not captured (unverified). Possible sponsor involvement was not assessed.
  16. [16]Systematic review of randomized controlled trials on interventions for melasma: an abridged Cochrane review · J Am Acad Dermatol, 2014 · read at abstract levelEstablishes: 20 randomised trials, 2,125 participants: triple-combination cream beat hydroquinone alone (RR 1.58), azelaic acid 20% beat hydroquinone 2% (RR 1.25), and tretinoin beat placebo.Does not establish: Long-term outcomes or relapse. Methodology was poor and the studies were short.
  17. [17]Melasma Treatment: An Evidence-Based Review · Am J Clin Dermatol, 2020 · read at abstract levelEstablishes: Across 113 controlled trials and 6,897 participants: triple combination cream and hydroquinone were the most effective. Oral tranexamic acid is promising for moderate or severe recurrent melasma. Peels and lasers showed mixed or inferior results with more adverse events.Does not establish: Long-term results — studies were small with short follow-up.
  18. [18]Hydroquinone (bleaching cream) · DermNet (NZ), 2021Establishes: Hydroquinone inhibits tyrosinase and acts on epidermal (not dermal) pigment. The typical course described is twice daily for about 3 months, stopped if there is no improvement, then twice-weekly maintenance. Risks include irritant dermatitis (more likely above 4%) and exogenous ochronosis with prolonged high-concentration use. It is prescription-only in NZ and many countries.Does not establish: A universal maximum duration — it sets none. Legal status outside NZ is not detailed.
  19. [19]FDA works to protect consumers from potentially harmful OTC skin lightening products · US Food and Drug Administration (Drug Safety Communication), 2022Establishes: Under the CARES Act, over-the-counter skin lighteners containing hydroquinone needed FDA approval to be legally marketed from 23 September 2020, and there are no approved OTC skin lighteners. Reported harms include rash, facial swelling and exogenous ochronosis, which may be permanent. At the date of the notice (April 2022) the only FDA-approved hydroquinone product was a prescription triple-combination cream for melasma.Does not establish: That hydroquinone does not work — the finding is regulatory, not about efficacy. It says nothing about prescription products after April 2022, or about any market outside the US: the EU cosmetics ban this entry used to mention is not on this page.
  20. [20]Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: randomized double-blind placebo-controlled trial · Br J Dermatol, 2015 · read at abstract levelEstablishes: In 50 patients, cysteamine 5% beat placebo on MASI and colorimetry after 4 months.Does not establish: Anything beyond epidermal melasma, including PIH. Small trial.
  21. [21]Efficacy and safety of cysteamine 5% cream for melasma: systematic review and meta-analysis of RCTs · Arch Dermatol Res, 2024 · read at abstract levelEstablishes: 7 randomised trials: cysteamine beat placebo, with no significant difference from hydroquinone 4%. Irritation rates were similar to hydroquinone and higher than placebo.Does not establish: That cysteamine and hydroquinone are equivalent — few, small trials cannot show that.
  22. [22]A Double-Blind, Randomized Clinical Trial of Niacinamide 4% versus Hydroquinone 4% in the Treatment of Melasma · Dermatol Res Pract, 2011 · read at abstract levelEstablishes: Split-face RCT in 27 patients over 8 weeks: both sides improved with no colorimetric difference. Good-to-excellent response was 44% with niacinamide vs 55% with hydroquinone. Side effects were 18% vs 29%.Does not establish: Equivalence — too small and too short to show it.
  23. [23]Tranexamic acid as a therapeutic option for melasma management: meta-analysis of RCTs · J Dermatolog Treat, 2024 · read at abstract levelEstablishes: 22 randomised trials, 1,280 patients: tranexamic acid reduced melasma severity. The largest MASI drop was with oral use, then injection, then topical. Side effects included stomach upset and menstrual changes.Does not establish: Long-term safety, which is not established. Heterogeneity between trials was high.
  24. [24]Tranexamic Acid for Hyperpigmentation Disorders: Efficacy and Safety in Melasma and PIH · J Cosmet Dermatol, 2026 · read at abstract levelEstablishes: Oral tranexamic acid (250–500 mg twice daily in the studies reviewed) produced improvement with mostly mild side effects. Topical and intradermal forms were comparable to hydroquinone with fewer irritant reactions. PIH is covered.Does not establish: Systematic grading — it is narrative. Evidence for PIH specifically is thin.
  25. [25]Mercury Poisoning Linked to Skin Products · US Food and Drug Administration, Consumer Updates, 2022Establishes: Mercury is illegally added to some skin lighteners and anti-ageing creams. Label terms to watch: mercurous chloride, calomel, mercuric, mercurio, mercury. These products are often sold in shops serving Latino, Asian, African and Middle Eastern communities, and online. Health effects are listed, and if exposed FDA's steps are to stop use, wash, contact poison control, and seal the product.Does not establish: That every unlabelled product contains mercury, or how common exposure is.
  26. [26]FDA Warns Consumers of Skin Products Containing Mercury and/or Hydroquinone · US Food and Drug Administration (Health Fraud), 2026Establishes: FDA testing since 2019 found some lighteners with mercury at 47 to 27,762 ppm and/or hydroquinone. The products were marketed as whitening, bleaching or brightening, came from several countries, and were sold on large online marketplaces. Kidney, nerve and skin harms are listed. Repeats that there are no legal OTC lighteners in the US.Does not establish: Steroid adulteration, which it does not cover. It does not show that every product using the word 'brightening' contains these ingredients.
  27. [27]Melasma: Diagnosis and treatment · American Academy of Dermatology, 2022Establishes: Treatments listed: hydroquinone, tretinoin, corticosteroid, triple combination cream, azelaic acid, kojic acid, vitamin C, and topical or oral tranexamic acid. Procedures listed: peels, microneedling, laser/light, PRP. Results take 3–12 months, and melasma can persist despite treatment.Does not establish: Procedure risks specific to darker skin, or any comparison of efficacy.
  28. [28]Unregulated skin-lightening cream use causing topical steroid-induced dermatitis and nodulocystic acne · BMJ Case Rep, 2025 · read at abstract levelEstablishes: An unlabeled lightening cream was found on analysis to contain undisclosed clobetasol propionate 0.05%. After 12 months of use it caused facial redness, progressive darkening, and severe acne after stopping.Does not establish: How common steroid adulteration is — a single case.
  29. [29]Finding skin cancer in darker skin tones · American Academy of Dermatology, 2025Establishes: People with darker skin need sun protection too. Skin cancer in darker skin is often advanced by the time it is diagnosed. Advises tinted iron-oxide SPF30+ broad-spectrum water-resistant sunscreen.Does not establish: Prevalence figures for pigmentation.
  30. [30]Visible light. Part II: Photoprotection against visible and ultraviolet light · J Am Acad Dermatol, 2021 · read at abstract levelEstablishes: Organic and inorganic UV filters do not protect against visible light; tinted sunscreens do. Regulation of visible-light protection differs by region.Does not establish: A standard for testing or labelling visible-light protection — it does not define one, so it cannot say how much a given tinted product blocks.
  31. [31]Questions and Answers: FDA announces new requirements for OTC sunscreen products · US Food and Drug Administration, 2011Establishes: SPF measures protection against UVB (sunburn). 'Broad Spectrum' means UVA protection in proportion to UVB protection.Does not establish: Anything about visible light, which it does not address at all. The label rules in force today may have been updated since 2011; that was not checked.
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