Melasma is a common form of hyperpigmentation characterised by brown or grey-brown patches that typically appear on the cheeks, forehead, upper lip, nose and chin. It disproportionately affects women — particularly those with darker skin tones — and is closely associated with hormonal influences, making it particularly common during pregnancy (when it is sometimes called the mask of pregnancy) and in those taking hormonal contraceptives. It is also significantly worsened by UV exposure.
Melasma is notoriously difficult to treat and has a strong tendency to recur — but with the right clinical approach, it can be very effectively controlled and significantly improved. Here is what works.
What Causes Melasma?
Melasma is caused by an overactivation of melanocytes — the pigment-producing cells in the skin — in response to hormonal influences and UV exposure. The exact mechanism is not fully understood, but oestrogen and progesterone appear to stimulate melanocytes directly, which is why melasma is so closely linked to pregnancy, the contraceptive pill and hormone replacement therapy. UV exposure dramatically exacerbates melasma by triggering additional melanin production and is the main reason why melasma tends to worsen in summer and improve in winter.
The fact that melasma has both a hormonal driver and a UV driver is why it requires a dual approach: treating the existing pigmentation while providing rigorous UV protection to prevent new pigmentation forming and existing pigmentation deepening.
Why Is Melasma So Difficult to Treat?
Melasma is more complex than other forms of hyperpigmentation for several reasons. First, it can occur in both the epidermis (surface layers) and the dermis (deeper layers), and dermal melasma is significantly harder to treat with topical products. Second, as long as the hormonal trigger is present — whether from pregnancy, contraceptives or natural hormonal cycles — melanocytes remain primed for overactivation. Third, even successfully treated melasma has a high recurrence rate without ongoing maintenance, particularly with sun exposure. This is why melasma management is a long-term commitment rather than a course of treatment.
The Most Effective Ingredients for Melasma
Tranexamic Acid
Tranexamic acid has emerged as one of the most effective topical ingredients for melasma, with a particularly strong evidence base for its use in hormonal pigmentation. It works by inhibiting the interaction between keratinocytes and melanocytes that drives melanin overproduction. SkinCeuticals Discoloration Defense combines tranexamic acid with kojic acid, niacinamide and HEPES in a formula clinically proven to improve melasma and other forms of discolouration in 12 weeks.
Kojic Acid
Kojic acid inhibits tyrosinase — the key enzyme in melanin synthesis — and is one of the most widely used brightening actives for melasma. In the SkinCeuticals Discoloration Defense formula, kojic acid works synergistically with tranexamic acid for a more comprehensive multi-mechanism approach than either ingredient alone provides.
Niacinamide
Niacinamide reduces the transfer of melanin from melanocytes to the skin cells at the surface, reducing visible pigmentation intensity. It also improves skin barrier function and has anti-inflammatory properties that reduce the inflammatory component of melasma.
Vitamin C
Applied every morning, a clinical Vitamin C serum neutralises the free radicals generated by UV exposure — the key trigger for melanocyte activation — while independently inhibiting tyrosinase. SkinCeuticals Phloretin CF is the strongest SkinCeuticals formula for skin discolouration, combining Vitamin C with phloretin for a dual inhibition of melanin synthesis. SkinCeuticals C E Ferulic provides the antioxidant protection that is fundamental to any melasma management programme.
Retinol
Retinol accelerates cell turnover, shedding melanin-containing surface cells at a faster rate and progressively revealing more even-toned skin. ZO Skin Health Retinol Skin Brightener 0.5% or 1% is named specifically for this dual action and is an essential component of an evening melasma routine.
Daily SPF — The Most Important Step of All
For melasma, daily SPF is not just important — it is the most critical component of any treatment programme. Without rigorous, daily, generous SPF application, every other treatment is working against an ongoing UV trigger that will continue to stimulate melanocyte overactivation. SkinCeuticals Advanced Brightening UV Defense SPF 50 is our most recommended SPF for melasma — it combines broad-spectrum SPF 50 with brightening actives that work synergistically with your treatment routine.
A Clinical Melasma Routine
Morning
SkinCeuticals Simply Clean or ZO Skin Health Exfoliating Cleanser → SkinCeuticals C E Ferulic or Phloretin CF → SkinCeuticals Discoloration Defense (apply to affected areas) → SkinCeuticals Metacell Renewal B3 → SkinCeuticals Advanced Brightening UV Defense SPF 50
Evening
Double Cleanse (Bioderma Sensibio H2O + cleanser) → SkinCeuticals Glycolic 10 Renew Overnight (2-3 nights per week) OR ZO Skin Health Retinol Skin Brightener 0.5% or 1% (alternate nights) → SkinCeuticals Discoloration Defense → SkinCeuticals Metacell Renewal B3 or Triple Lipid Restore 2:4:2
Professional Treatments for Melasma
Melasma responds well to professional treatments combined with a rigorous home routine. Superficial chemical peels with glycolic or lactic acid progressively improve surface pigmentation. Certain light and laser treatments can be effective but must be used with great caution in melasma as some laser treatments can trigger a rebound worsening of pigmentation in susceptible individuals — always seek experienced professional advice before pursuing laser treatment for melasma specifically.
Managing Expectations
Be realistic and patient. Melasma is a chronic condition that requires ongoing management rather than a cure. Expect visible improvement over 8 to 16 weeks with a consistent clinical routine. Maintain diligent SPF use indefinitely. Consider adjusting or changing hormonal contraceptives in discussion with your doctor if melasma is a significant concern. And invest in regular professional treatments to accelerate the correction that home skincare achieves progressively.
Browse our pigmentation skincare range at Esthe Clinic or book a consultation for a personalised melasma management plan.