How to treat melasma and hyperpigmentation, according to dermatologists

Hyperpigmentation, recognized by darker patches of skin due to increased melanin production, is one of the most common skin conditions, with melasma (a form of hyperpigmentation) affecting nearly 5 million people in the United States. Though some types of hyperpigmentation fade naturally or with age, most take longer to go away and require a treatment plan. This is less intimidating than it sounds, however, with plenty of derm-approved skin care products out there to help.

Here, we consult dermatologists to home in on the root causes of hyperpigmentation and melasma and how to best to treat uneven skin tones.

What causes hyperpigmentation?

Though studies show that women and skin of color — with increased melanin levels — are more at risk of hyperpigmentation, it is a common concern for all ages, genders and skin types. “Melanin is a substance in your body that produces hair, eye and skin pigmentation,” says Dr. Blair Murphy-Rose, a New York City-based board-certified dermatologist. “There are several factors that can trigger an increase in melanin production, but the main ones are age, hormones, sun exposure and skin injuries or inflammation.”

There are two main ways that hyperpigmentation appears on the skin — localized or diffuse — the former arriving in more concentrated, smaller patches, while the latter manifests in larger, dispersed areas. Localized hyperpigmentation is the most common and is often caused by injury or inflammation to the skin, such as UV damage, acne and hormonal fluctuations seen during pregnancy or when taking birth control.

Then, there are three main types of hyperpigmentation — post-inflammatory hyperpigmentation (PIH), age spots (also known as solar lentigo) and melasma — each of which have distinct root causes and ways to best approach treatment. “Melasma quite classically presents as pigmented patches in a butterfly pattern on the cheeks and forehead,” explains board-certified dermatologist Dr. Teo Wan Lin. “PIH tends to have fuzzy borders, whereas age spots have a discrete edge.

“Skin of color is prone to hyperpigmentation in general,” Teo continues. “Dry or eczema-prone skin may develop worse [hyperpigmentation] symptoms compared to those with oily or combination skin because of a weakened skin barrier.”

What is melasma?

Melasma is a common skin disorder and type of hyperpigmentation that is mainly present amongst pregnant women. The condition is most commonly triggered by an increase in the hormones estrogen and progesterone, but can also be caused by UV exposure, thyroid disease and certain medications such as retinoids, blood pressure medication and birth control pills. “Melasma is a common acquired disorder of hyperpigmentation that affects sun-exposed areas,” Murphy-Rose says. “It appears as hyperpigmented, irregular patches and most commonly affects women of reproductive age and only rarely occurs in males. It has been linked to sun exposure and estrogen.”

According to the American Board of Dermatology, melasma often manifests during a woman’s reproductive years, and is most common amongst those with medium to dark skin tones and predisposed genetic factors. A recent study found that almost half of surveyed melasma patients have a relative with the condition.

When melasma appears, it will form tan, brown or blue freckle-like spots or patches. While it is most found on the face, cheeks, forehead and chin, it can also appear on the legs, arms and neck. “The hormonal aspect is largely what differentiates melasma from hyperpigmentation and can make it more difficult to resolve,” says Chanel Jenae, Arcona owner, creative director and esthetician. “Melasma typically looks more like patches on the face, whereas hyperpigmentation can appear as sunspots, dark spots or freckles and is usually more diffused.”

How to treat melasma and hyperpigmentation

“To treat melasma, getting a dermatologist involved is key,” says Dr. Brandith Irwin, board-certified dermatologist and founder of skintour.com and MadisonMD Skincare. “If the problem is post-inflammatory hyperpigmentation — acne, a superficial scrape — then it may be reasonable to try at-home remedies, such as the MadisonMD Skin Care Uneven Pigment Fighter, for a month or two.”

Irwin advises that resurfacing treatments, such as lasers, may worsen melasma unless conducted by an expert. However, laser treatments are often better suited to aid other forms of hyperpigmentation, especially if caused by sun damage. Though most opt for at-home treatments and care, the quickest way to treat for hyperpigmentation is through dermatological procedures such as chemical peels, lasers, microdermabrasion and dermabrasion. For at-home users, look for products that are rich in alpha hydroxy and kojic acids and vitamin A (such as retinol and tretinoin), all of which aid in cell turnover and skin rejuvenation.

Though treatments are vital in treating hyperpigmentation, dermatologists advise that prevention is one of the best forms of treatment. “Proper suncare — SPF, wearing hats, protective clothing and tinted SPFs — are all beneficial.” says Irwin. “Wear hats with a full brim when outside whenever possible. If you have melasma on the forearms, keep them covered. If you’re not sure what pigment is due to, see a dermatologist as soon as possible.”

Best products for melasma and hyperpigmentation