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DermCafé's Melasma Series: Causes and Treatments


Melasma commonly appears as brown-grey patches on the face. Although an exact is cause is not known, many factors are related.

#1) Ultraviolet (UV) light from the sun stimulates the melanocytes (pigment cells in your skin).

This is why:

  • Melasma is often worse in summer.

  • Even a small amount of sun exposure can make melasma return after fading.

  • Many people with melasma get it again and again.

#2) Female Hormones

Pregnant women often get melasma (called chloasma, or the mask of pregnancy).

Birth control pills and hormone replacement medicine also can trigger melasma.

#3) Skincare Products:

Simply put, if a product irritates your skin, it can trigger/worsen melasma.

#4) Genetics:

Over 40% of patients report having relatives affected with this condition

#5) Blue light from LED screens?

Recently, some studies have suggested a connection between blue light from LED screens and melasma. This has not been yet been substantiated via strong scientific studies.


Treatment Principles:

Sun protection: Arguably more important than treatment because it prevents worsening discolouration

Stop further pigmentation: Melasma is not a static condition, and can darken / enlarge over time, depending on various aggravating factors

Remove existing pigmentation: The most effective treatment often involves both prescription topicals & professional procedures (e.g. chemical peels, laser treatments, etc)

Initial Treatment:

Prescription hydroquinone (HQ) combination creams

  • Combination creams contain additional prescription-level ingredients including kojic acid, retinoids, and others

  • HQ inhibits tyrosinase, a protein that helps to produce skin pigment

  • Over-the-counter HQ 4% versions are often insufficient to produce a notable effect

  • ⚠️Topical HQs should be used under medical supervision due to pigmentation risks with long-term use ⚠️

Maintenance Treatment:

Because HQ cannot be used safely long-term, non-HQ topical options are used for maintenance

  • Azelaic acid

  • Kojic acid

  • Niacinamide

  • Vitamin C

  • Arbutin

  • Etc

These formulations can be used in an alternating fashion with HQ treatment periods

Ongoing Treatment:

  • Daily SPF30 photoprotection, ideally with a tinted, mineral formulation to block visible light

  • Removing risk factors: oral contraceptives, hormonal treatments, etc

  • Professional Procedural Treatments:

    • Chemical peels

    • Lasers treatments

    • ⚠️Always speak to a Board-Certified Dermatologist to guide your decision ⚠️

Book now with a

Board-Certified DermCafé Dermatologist to learn more!

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