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melasma treatment optionsMelasma is a common problem that causes dark, discolored patches of skin that typically develops on the forehead, nose, upper lip, and cheeks. While the condition is not serious, it can affect someone’s appearance and can be embarrassing. Fortunately, a number of treatment options can help reduce the appearance of discolored skin associated with melasma.

The condition can affect men, but about 90 percent of those who develop melasma are women. Sometimes known as “mask of pregnancy,” the condition often occurs during pregnancy. It can also develop in women taking birth control pills. In these cases, melasma disappears after pregnancy or discontinuation of birth control pills.

Researchers are still investigating the exact cause of melasma, but they do know that certain factors contribute to the development of this skin condition. People with darker skin are more at risk for melasma than are lighter-skinned individuals. Sensitivity to the hormones estrogen and progesterone also increases the risk for developing melasma, so birth control pills, pregnancy, and hormone therapy can all trigger the skin condition. Stress and thyroid disease may also play a role.

Melasma may also develop as a result of sun exposure. Ultraviolet (UV) rays from the sun stimulate the skin’s production of melanin, a brown to black pigment that gives skin its color.

Treatment for Melasma Can Reduce Dark Skin Patches

The dark skin patches of melasma can fade on their own. This is especially true when a specific trigger, such as pregnancy or birth control, causes the condition.

Some people can experience melasma for years, or even throughout their lives. If melasma does not go away by itself, or if a woman wants to continue using birth control pills, treatment can help make the dark spots fade.

A number of treatments are available. These treatments may involve topical medications that patients can apply to their skin.


Skin health specialists often recommend hydroquinone as the first line of treatment for melasma. Hydroquinone is available as a cream, lotion, liquid, or gel applied to the skin. It works by lightening the skin, or skin bleaching.

Products containing small amounts of hydroquinone may be available without a prescription. Preparations containing larger amounts of hydroquinone are available only with a prescription.

Tretinoin and corticosteroids

Dermatologists sometimes recommend a second medication, such as tretinoin or a corticosteroid. Tretinoin, also known as retinoic acid, is a synthetic form of vitamin A; it is available under a number of brand names. Tretinoin works by lightening skin and by replacing older skin with fresh, new skin. Corticosteroids provide a potent bleaching action; they also reduce skin inflammation, which can reduce the risk of dermatitis when used alongside other skin lightening treatments.

Skin health specialists might also recommend a “triple cream,” which is a medication that contains hydroquinone, tretinoin, and a corticosteroid.

Other topical medications

Dermatologists sometimes prescribe other topical medications, such as azelaic acid or kojic acid, to help lighten melasma. Azelaic acid targets over-active production of the pigment, melanin, in skin cells to help lighten dark spots without lightening the normal skin. Azelaic acid can also help reduce the appearance of blemishes for flawless skin.

Kojic acid inhibits the formation of tyrosine, which is an amino acid that plays an important role in the production of melanin. Produced by fungus or as a byproduct of fermenting rice, Kojic acid also has antimicrobial effects, so it can help reduce the appearance of acne caused by bacteria in the skin. It may also lighten stubborn acne scars.


Certain procedures can remove dark spots associated with melasma safely and effectively. These procedures include chemical peels, liquid nitrogen, skin bleaching, microdermabrasion, and laser resurfacing. Only dermatologists should perform these procedures, as new skin problems may develop when the treatment is not tailored to the patient’s skin type or is performed incorrectly.

Chemical peels

A chemical peel removes the outer layer of skin, known as the epidermis, through a slow and controlled process that destroys the skin. Removing the epidermis in this way allows new skin to form without excess pigmentation from melasma.

Liquid nitrogen

Liquid nitrogen treatment, also known as freezing or cryotherapy, uses extreme cold to freeze off skin tissue and destroy the excess pigment that causes melasma. Dermatologists use cotton swabs to apply liquid nitrogen directly to the affected areas; the liquid nitrogen remains on the skin for only a few seconds. After treatment, the skin appears lighter as it heals. This approach works for small areas of spots.


Microdermabrasion involves removing the top layer of skin in a process known as exfoliation. To perform microdermabrasion, the dermatologist uses a wand that sprays aluminum oxide or sodium chloride crystals onto the patient’s facial skin. The wand also provides suction to remove the dead skin cells and crystals from the skin, along with any other impurities on the skin. Microdermabrasion allows the growth of fresh, spot-free skin.

Laser resurfacing

Laser resurfacing uses the power of light energy to remove the epidermis. In addition to removing brown spots, this non-invasive procedure can also reduce the appearance of wrinkles, sagging skin, enlarged pores and other skin problems.

If you have melasma that does not go away, contact the dermatologists at the Center for Dermatology and Laser Surgery here, or call 503-297-3440. Your skincare professional may be able to recommend a medication or procedure to help reduce melasma and the brown spots it causes.