Melasma (Facial Spots): Causes and Treatment

Briefly, what you need to know

Not every brown spot on the face is melasma.

Melasma is more common in women, but it can also occur in men.

The sun is a significant trigger.

Visible light can also affect pigmentation.

It may be related to pregnancy and hormonal factors.

Permanently eliminating it with a single cream or a single laser session is often unrealistic.

Incorrect or aggressive treatments can increase pigmentation.

In addition to treatment, photoprotection to prevent recurrence is of fundamental importance.

Are all facial spots melasma?

No.

The appearance that patients describe as "spots" may be caused by various factors:

Melasma: Typically symmetrical and irregularly bordered brown areas on the face.

Solar lentigo: More localized sunspots associated with prolonged sun exposure.

Post-inflammatory hyperpigmentation: Dark spots remaining after acne, eczema, irritation, or other inflammation.

Freckles: Small, pigmented areas associated with genetic predisposition and which can become more prominent with sun exposure.

Their treatments are not the same. Therefore, it is necessary to first determine what the lesion is, and then choose the treatment.

What causes melasma?

There is no single cause of melasma.

Genetic predisposition can be important. In addition, ultraviolet radiation, visible light, hormonal factors, and various cellular mechanisms that affect pigment production also play a role.

Because it can appear during pregnancy, it is sometimes known as "pregnancy mask" among the public. However, melasma does not only occur during pregnancy.

Some hormonal medications can also be effective in susceptible individuals.

Does the sun worsen melasma?

Yes. Photoprotection is a fundamental part of melasma management.

However, the issue is no longer just about protection from UV rays. There is strong evidence that visible light can also affect melanogenesis, especially in skin prone to pigmentation. Reviews from 2025 and 2026 support the possibility that pigmented/tinted sunscreens that provide protection against visible light may offer additional benefits in cases of melasma and other hyperpigmentation conditions.

Therefore, in suitable patients, it may be necessary to consider not only the sun protection factor (SPF) value but also a photoprotection strategy that can provide protection against broad-spectrum and visible light.

How is melasma diagnosed?

In most patients, the diagnosis can be made through a dermatological examination.

The stain;

distribution,

color,

when it emerged,

its relationship with the sun,

medications used,

pregnancy or hormonal factors,

Previous treatments are evaluated.

If necessary, dermoscopic evaluation or other辅助 methods may be used.

How is melasma treated?

There is no single treatment for melasma that works for everyone.

We can roughly divide the treatment into four parts:

Photoprotection + treatments that reduce pigment production + selected supportive procedures + long-term recurrence control.

Topical treatments for skin lightening

Hydroquinone is one of the longest-used and best-documented agents for treating melasma. Triple combination therapies containing hydroquinone also have a strong evidence base and are among the key treatment options in the 2025 international consensus.

Azelaic acid and other depigmenting agents may also be evaluated on a case-by-case basis.

Not all of these products should be considered "cosmetic spot creams." Especially for strong depigmentation treatments, the duration and method of use should be dermatologically planned.

Tranexamic acid

Tranexamic acid has become a significant option in the treatment of melasma in recent years. Studies exist on its topical, intradermal, and oral use.

Oral tranexamic acid, in particular, may be effective in appropriately selected patients; however, it is not suitable for everyone and requires medical evaluation due to important safety concerns such as thromboembolic risk. Current consensus considers it among the treatment options for select patients.

Chemical peels and microneedling

In some patients, it can be used as an adjunct to topical treatments.

Meta-analyses of randomized studies suggest that microneedling may be beneficial as an adjunct therapy; however, it should not be considered a miracle cure to replace primary treatment.

Can laser treatment cure melasma?

Laser selection for melasma treatment should be done carefully.

Melasma is not a blemish that can be treated with laser surgery.

Laser and light systems may be beneficial in some selected, particularly resistant cases. However, melasma can recur, and inappropriate parameters or patient selection can lead to worsening of pigmentation.

The 2025 international consensus reserves lasers more for refractory cases. Furthermore, a meta-analysis of picosecond Alexandrite published in 2026 found that in the randomized trials examined, a triple combination cream was superior to picosecond laser in MASI improvement.

Therefore, marketing claims promising definitive results in melasma are not scientifically accurate.

“"We completely eliminate melasma with the latest laser."”

Such definitive statements should not be used.

Does melasma completely disappear?

Significant improvement can be achieved in melasma. However, recurrence is one of the most common problems.

Therefore, evaluating successful treatment solely based on whether "the stain has lightened" is incomplete.

Aim:

The goal is to reduce pigmentation → limit new pigment formation → control triggers → and preserve the achieved result as much as possible.

This long-term approach is also one of the key messages of current consensus.

What precautions should be taken at home?

The most important point is consistent photoprotection.

In addition:

to avoid unnecessarily irritating the skin,

Avoid uncontrolled peeling and acid combinations.,

Avoid using strong skin lighteners for extended periods without a dermatologist's recommendation.,

not constantly changing treatment just because it doesn't show results in a few weeks

It is important.

Being aggressive in treating melasma doesn't always mean being more effective.

When should you consult a dermatologist?

Dermatological evaluation is appropriate if there is new or progressively increasing pigmentation on the face, if it is unclear whether the spot is melasma, if a connection to pregnancy/hormonal factors is suspected, if the products being used are irritating, or if the pigmentation has worsened with previous spot treatments.

Frequently Asked Questions

Is melasma contagious? No.

Is melasma cancer? No. Melasma is a pigmentation disorder.

Does melasma go away after pregnancy? It may lessen in some people; in others it may persist.

Is sunscreen sufficient for melasma? Photoprotection is an essential part of treatment, but it is not sufficient on its own to treat existing melasma in most patients.

Are tinted sunscreens better for melasma? Some tinted sunscreens, especially those containing pigments like iron oxide, can provide additional protection against visible light and may be advantageous for people prone to hyperpigmentation. However, not all "tinted" products offer the same level of visible light protection. Product analyses from 2026 show significant shortcomings in labeling and standardization.

Which is better for melasma: laser or cream? It's not accurate to rank them all. Current approaches focus on photoprotection and topical treatments; device-based therapies can be added in selected cases.