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Treating Pigment and Melasma

Treating Melasma often involves multiple strategies. Below is a TEMPO guide to common treatments and approaches!

Melasma is a common skin condition characterized by brown or grayish patches, mainly on the face. It's more frequently observed in women, especially during pregnancy (often called the "mask of pregnancy") or among those using oral contraceptives or hormonal replacement therapy, indicating a hormonal component to its cause. Sun exposure is also a significant contributing factor due to the stimulation of melanocytes (the melanin-producing cells) by UV light.

Treating melasma can be challenging and requires a multifaceted approach. Here's an overview of common treatments and strategies:

1. Sun Protection

  • Sunscreen: Crucial in the management of melasma. Broad-spectrum sunscreens with an SPF of at least 30 should be applied daily, even on cloudy days or when indoors, as UVA rays can penetrate windows.

  • Physical barriers: Hats and clothing that shield the skin from the sun can also help.

2. Topical Treatments

  • Hydroquinone: A skin-lightening agent, is considered a first-line treatment for melasma. It decreases the formation of melanin. However, due to concerns about its potential for causing ochronosis (skin darkening) with prolonged use, it's often recommended for limited periods.

  • Tretinoin and Corticosteroids: These can help lighten melasma by enhancing skin turnover and reducing inflammation, respectively. They are sometimes combined with hydroquinone in a formulation known as triple cream.

  • Other lightening agents: Include azelaic acid, kojic acid, and ascorbic acid (vitamin C), which can be effective and might be used as alternatives or adjuncts to hydroquinone.

3. Procedures

  • Chemical peels: Can help by promoting the removal of the outer layer of skin, thus lightening melasma. Peels should be chosen based on skin type and sensitivity.

  • Laser treatments and intense pulsed light (IPL): Can be effective for some individuals but may also carry a risk of worsening melasma or causing post-inflammatory hyperpigmentation, especially in darker skin types. Careful selection of candidates and parameters is critical.

  • Micro-needling: Sometimes used in combination with topical treatments to enhance their penetration.

4. Oral Medications

  • Tranexamic acid: Originally used to treat or prevent excessive blood loss, tranexamic acid has shown promise in treating melasma when other treatments haven't worked. It's thought to work by inhibiting the plasminogen/plasmin pathway, which can influence melanogenesis (the production of melanin).

5. Combination Therapies

Often, a combination of the above treatments yields the best results. The approach should be tailored to the individual's skin type, the severity of the melasma, and their response to previous treatments.

Lifestyle Adjustments

  • Avoiding known triggers: Such as sun exposure and hormonal triggers.

  • Gentle skin care: Using mild, non-irritating products can help avoid aggravating melasma.


  • Patience and consistency: Melasma treatment is often a slow process, requiring several months to see significant improvements. Consistency in applying treatments and protecting the skin from the sun is crucial.

  • Potential for recurrence: Melasma can be persistent and may recur, especially with sun exposure or hormonal changes. Ongoing management may be necessary.

Due to the complex nature of melasma, a multi-pronged treatment approach customized to the individual's specific situation is often most effective. Dermatologists play a key role in diagnosing the condition, ruling out other causes of hyperpigmentation, and developing an appropriate treatment plan. It's essential for patients to have realistic expectations and to understand the importance of adherence to the prescribed treatment regimen, including rigorous sun protection.

Interested in treating your melasma? Schedule an aesthetic consultation with one of our providers today!


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