Melasma & Dark Spots

Melasma is a chronic form of hyperpigmentation that appears as brown or gray-brown patches on the skin, typically on the face. It affects women far more often than men and is especially common during reproductive years.

Melasma develops when melanocytes produce excess pigment. Common triggers include:

• Sun and visible light exposure
• Hormonal changes (pregnancy or birth control)
• Genetics
• Thyroid disorders

Even minimal sun exposure can worsen existing melasma.

Dark spots—also known as sun spots, age spots, or liver spots—are localized areas of excess pigmentation caused primarily by UV exposure. Unlike melasma, dark spots tend to be smaller, more defined, and increase with age.

Melasma frequently appears on the cheeks, forehead, nose, chin, and upper lip. When pigmentation develops above the upper lip, it can resemble a mustache — a common and frustrating presentation.

Melasma is not harmful and does not increase the risk of skin cancer. However, many people experience emotional distress, lowered self-esteem, or reduced quality of life due to visible discoloration.

Melasma most commonly appears on the face but can also develop on:

• Neck
• Forearms
• Upper chest

Hyperpigmentation is a broad term for any skin darkening. Melasma is a specific type of hyperpigmentation caused by hormonal and genetic factors, often worsened by sun exposure.

Melasma	Sun Spots
Often hormone-related	Caused by UV exposure
Larger patches	Small, defined spots
Common in younger women	More common after age 50
Chronic and recurring	Usually permanent but stable

Yes. Melasma is very common during pregnancy and is sometimes called the “mask of pregnancy.” Hormonal changes combined with sun exposure increase the risk of developing pigmentation.

Yes. Daily use of broad-spectrum sunscreen is essential. Tinted sunscreens with iron oxide are especially effective because they protect against visible light in addition to UVA and UVB rays.

There is no permanent cure. However, melasma and dark spots can be significantly improved and controlled with consistent sun protection and targeted treatments.

In some cases, melasma may fade over time—especially after pregnancy or stopping hormonal triggers. However, most people see the best improvement with prescription treatments and sun avoidance. Results typically develop gradually over several months.

Treatment plans often combine prevention and correction strategies:

Sunscreen

The foundation of all melasma treatment. Daily use helps prevent new pigment from forming and protects treatment results.

Prescription Topical Treatments

Clinically supported ingredients that help fade existing pigmentation include:

• Hydroquinone
• Azelaic acid
• Tretinoin and other retinoids
• Tranexamic acid
• Kojic acid
• Niacinamide

These work by reducing pigment production, inflammation, and abnormal blood vessel activity.

Chemical Peels

Chemical peels using glycolic or salicylic acid may help some patients but carry risks, including irritation or worsening pigmentation—especially for deeper skin tones.

Laser Treatments

Lasers can break up pigment but have a high risk of relapse and, in some cases, worsening melasma. They are generally not first-line treatment.

Prescription Medications for Melasma & Dark Spots

Common prescription options include:

• Tretinoin Cream (generic Retin-A®)
• Tazarotene Cream
• Adapalene Gel
• Azelaic Acid 15% Gel
• Hydroquinone Cream

Your provider will determine the best option based on your skin type and condition.

Most prescription treatments require consistent use for several months. Some patients see improvement within 8–12 weeks, while others may need 6–10 months for significant results. Patience and daily sunscreen use are key.

Some OTC products may help mild discoloration. Ingredients with evidence include:

• Alpha-hydroxy acids (glycolic acid)
• Kojic acid
• Retinol

However, OTC products are considered cosmetic and are not FDA-approved to treat melasma. Prescription treatments generally offer stronger, clinically proven results.

Yes. Telehealth allows you to consult with a licensed medical provider online. If appropriate, prescription treatments can be delivered discreetly to your home anywhere in the U.S.