Melasma – what is it, what causes it, and how can it be treated?

Melasma is a buildup of melanin—the pigment responsible for skin color—that appears as dark, irregularly shaped patches in varying shades of brown, standing out clearly against the natural skin tone.

Direct sun exposure is closely linked to the development of melasma, which is why it most commonly appears on the face, as facial skin is the hardest to shield from the sun. The discoloration usually appears symmetrically on both sides of the face—around the mouth, on the chin, forehead, and temples. Much less commonly, melasma can also appear on the legs, abdomen, or back.

Melasma doesn’t always look the same. Sometimes the discoloration on the face is more scattered, similar to freckles. In other cases—when particularly reactive melanocytes concentrate in one area—it can form large, noticeable patches.

The spots can also vary in how dark they are and how deep they sit within the epidermis. This means some are easier to fade, and the brightening process can take much less time. With darker, more extensive melasma, professional treatments may be needed to effectively address the condition.

Melasma is caused by the excessive and uneven production of melanin, the skin’s natural pigment. So what disrupts the process of melanogenesis—the production of melanin?

The main contributing factors are hormonal changes, genetic predisposition, and photosensitizing medications, which make the skin more sensitive to UV radiation—the key trigger without which melasma is unlikely to develop, or may appear only mildly. Sun exposure is the most important factor in both triggering and maintaining melasma.

In some people, this type of discoloration is linked to genetic predisposition. Melasma may run in the family. Their skin naturally reacts more strongly to sun exposure and is more prone to producing excess pigment.

Certain hormones can directly affect melanin production and make the skin more sensitive to UV radiation. That’s why hormonal imbalances—as well as the use of hormonal contraception or hormone replacement therapy—can also trigger melasma. Hormonal factors are also the main cause of pregnancy-related melasma.

Women often experience melasma during pregnancy because the body undergoes many changes, mainly due to hormonal fluctuations. During pregnancy, estrogen levels rise—hormones that, among other things, stimulate the activity of melanocytes, the cells responsible for producing melanin, the pigment in the skin. When hormonally stimulated to work more intensely, melanocytes contribute to the development of skin discoloration. These patches usually appear on areas exposed to sunlight—most commonly on the face.

Pregnancy-related melasma most often fades on its own within several weeks after giving birth. However, in some cases—especially in women who are prone to this type of cosmetic concern—the pigmentation can persist long after delivery. In such situations, it may be worth trying home remedies or professional treatments for melasma, but it’s important to remember that this should only be done after childbirth and once breastfeeding has ended. Many of the active ingredients commonly used to treat pigmentation can have a negative impact on a child’s development.

Preventing pregnancy-related melasma, as well as melasma unrelated to pregnancy, mainly involves avoiding intense sun exposure and, above all, using a high-SPF sunscreen. These habits should be a regular part of skincare for all pregnant women, as well as for anyone who knows their skin is prone to discoloration.

That said, even avoiding UV radiation does not guarantee complete protection against melasma. It can, however, significantly reduce the risk of developing extensive pigmentation that is difficult to remove.

If the pigmentation in the epidermis is not particularly extensive or deeply set, it’s worth incorporating creams and serums with vitamin A, along with gentle acids such as azelaic acid, kojic acid, lactic acid, or glycolic acid, into your skincare routine. Glycolic acid also helps exfoliate and regenerate the skin.

When treating melasma with vitamin A creams, consistency and patience are essential. Over time, they can help make the skin less reactive to sun exposure, as these products work by inhibiting melanocyte activity. It’s also important to remember that while using products containing acids and/or retinol, you should use stronger sun protection than usual to prevent new pigmentation from developing.

Properly selected exfoliants can be extremely helpful in a skincare routine aimed at reducing melasma. Enzyme peels in particular are recommended, especially those enriched with active ingredients that have brightening properties. Exfoliation not only removes the buildup of dead skin cells, but also helps creams, serums, and masks penetrate more deeply—making them more effective.

A peel for dark spots is based on intensive chemical brightening of pigmented areas. It works particularly well for skin affected by hyperpigmentation, sun-related dark spots, and uneven tone. It can be performed on any area of the body, but it is most commonly used on the face, neck, and décolletage.

The procedure is painless, and the first results are usually visible after the second application of the product. After treatment, the skin may appear pink and start to peel. These effects typically subside within 14–28 days after the procedure. It’s essential to use a very high SPF sunscreen after the treatment.

This is the Cosmelan treatment, which works on multiple levels. In addition to reducing sun spots, freckles, and melasma, it also brightens the complexion and helps soften fine lines. The formula contains ingredients that inhibit tyrosinase—an enzyme involved in melanin production. It’s also rich in vitamins A and C, which reduce oxidative stress, as well as kojic and azelaic acids that help convert dark pigment into a lighter one.

The treatment is painless, and the first results are typically visible about 30 days after the procedure. It consists of two stages: a medical consultation with the application of a special mask, followed by at-home care using a dedicated cream.

Another very popular specialist option for tackling pigmentation is laser treatment, recommended for melasma, sun-induced discoloration, and age spots. After the laser is applied, the pigmented areas may temporarily darken, then gradually flake off as the skin renews itself. The full result is typically seen after about 30 days.