The ESK blog
Melasma: What It Is, Why It Happens and Why It Keeps Coming Back
29 September 2026
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Written by Dr. Ginni Mansberg
If you've ever treated a cluster of facial pigmentation religiously for months with your daily SPF, actives, the works, only to watch it creep back within weeks of stopping, there's a good chance you're dealing with melasma.
Melasma is one of the most common forms of facial pigmentation, and one of the most misunderstood. It's not a simple dark spot you can fade and forget. It's a condition that's influenced by a combination of hormones, UV exposure, heat, and genetics. Which is exactly why it keeps coming back, and why getting on top of it requires a long-term strategy rather than a short-term fix.
Luckily, melasma can be significantly improved. The important thing is knowing what you're dealing with.
What Is Melasma?
Melasma is an acquired hyperpigmentation disorder, which means you're not born with it, but you can develop it at any point during your life, particularly during hormonally active years.
It typically appears as symmetrical, brown or grey-brown patches on sun-exposed areas of the face: the cheeks, forehead, upper lip, chin, and sometimes the nose and temples. The symmetry is one of its most recognisable features. It has a tendency to appear in matching patches on both sides of the face, creating what's sometimes described as a "mask" effect.
Melasma predominantly affects women of reproductive age, particularly those with Fitzpatrick skin types III–V (medium to deeper skin tones). It's estimated that only around 10% of people with melasma are men, though men can and do develop it- particularly those with genetic susceptibility and significant sun exposure.
Melasma affects millions of people worldwide, with reported prevalence ranging from around 9% in Latino women in the southern US to as high as 40% in some Southeast Asian populations. These differences reflect the combined influence of genetics, skin type, and sun exposure patterns.
Beyond its appearance, melasma can take a real emotional toll. Studies consistently show it affects confidence, self-esteem, and quality of life, particularly because of its facial location and its tendency to persist.
Melasma vs Hyperpigmentation
People often use "melasma" and "hyperpigmentation" interchangeably, but they're not the same thing.
Hyperpigmentation is the umbrella term for any darkening of the skin caused by excess melanin. It covers everything from post-acne marks to sunspots to melasma.
Melasma is a particular type of hyperpigmentation. What makes it different is the way it tends to show up symmetrically, the strong hormonal link behind it, and the fact that it behaves more like an ongoing, flare-prone condition than a simple mark you can treat once and be done with.
So, while all melasma is hyperpigmentation, not all hyperpigmentation is melasma. Understanding which type you're dealing with matters enormously, because the approaches that work well for, say, a post-acne dark spot may not be sufficient for melasma, and vice versa.
Melasma vs Sunspots
Both melasma and sunspots (solar lentigines) are forms of hyperpigmentation triggered by sun exposure, but they're quite different in how they look and behave.
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Appearance |
Larger patches with diffuse, irregular borders |
Smaller, discrete spots with more defined edges |
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Distribution |
Symmetrical, usually facial |
Sun-exposed areas: face, but also hands, forearms, décolletage |
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Cause |
Multifactorial: hormones, UV, heat, genetics |
Primarily cumulative UV damage over years |
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Who's affected |
Predominantly women of reproductive age |
Adults over 40, particularly fair-skinned people |
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Behaviour |
Chronic, relapsing, hormonally influenced |
Generally stable unless further sun exposure occurs |
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Depth |
Often mixed epidermal and dermal |
Usually epidermal |
The biggest practical difference: sunspots tend to be more straightforward to treat, because once UV exposure is managed, the trigger is largely removed. Melasma is more complex, because hormonal and heat triggers can be hard to control, even if you’re extremely diligent with sun protection.
What Causes Melasma?
Melasma is what scientists call a multifactorial condition. In other words, meaning it's rarely caused by just one thing. The most common triggers include:
Hormones
This is the most well-established trigger. Oestrogen and progesterone directly influence melanocyte activity via hormone receptors expressed in the skin. Oestrogen, in particular, enhances tyrosinase activity, the enzyme responsible for producing melanin, leading to increased pigment production.
This is why melasma is so closely associated with:
- Pregnancy — melasma is present in up to 75% of pregnant women and is sometimes called "the mask of pregnancy". Studies show that for 30% of women, melasma persists even after the baby is born.
- The oral contraceptive pill — approximately 10–29% of women using combined oral contraceptives develop melasma
- Hormone replacement therapy — particularly relevant for perimenopausal and postmenopausal women (although it is much rarer than for the pill)
When the hormonal trigger resolves (after pregnancy, or after stopping the pill), melasma sometimes improves on its own, though in many cases it persists.
UV Exposure
UV radiation is the most important activating factor for melasma, even in people who already have a hormonal predisposition. UV stimulates melanocytes directly, and it also triggers inflammatory pathways in surrounding skin cells (keratinocytes) that signal melanocytes to produce more pigment. Even without sun directly hitting your face, just being very hot stimulates melanogenesis- or your melanocytes making more pigment.
This is why melasma almost always worsens in summer and often improves somewhat in winter. And why daily, consistent sun protection is the non-negotiable foundation of any melasma management plan.
Genetics
Genetics play a bigger role in melasma than many people realise. In a global survey of 324 women with melasma, 48% had a family history of the condition. And of those with a positive family history, 97% had an affected first-degree relative. Some studies put the family history figure even higher, at 55–64%.
This suggests that melasma follows something close to a dominant inheritance pattern, where a genetic predisposition to more reactive melanocytes is passed down in families. If your mother or grandmother dealt with melasma, you're at meaningful elevated risk.
Genetic susceptibility doesn't mean melasma is inevitable. But it does mean that when triggers like hormones and UV exposure are present, your skin is more likely to respond with significant pigmentation than someone without that predisposition.
Other Factors
A few other triggers are worth knowing about:
- Certain medications including some antibiotics, anticonvulsants, and photosensitising drugs can worsen melasma
- Cosmetics and skincare. Irritating or photosensitising ingredients can flare melasma. Typical culprits include some forms of vitamin A and AHAs (alpha hydroxyacids)
- Stress. Cortisol and other stress hormones seem to impact melanocyte functioning, though the research here is less robust than for oestrogen
Does Heat Make Melasma Worse?
Yes. This is something many people with melasma don't know about until they've been frustrated by pigmentation that keeps returning despite excellent SPF compliance.
Heat is an independent trigger for melanogenesis (melanin production) that operates completely separately from UV exposure. It seems that you need repeated and prolonged exposure to heat for this to happen. What this means in practice: your skin can be perfectly protected from UV rays and still have melasma triggered or worsened by heat alone.
It can also have implications for many cosmetic procedures that use heat to achieve their benefits.
Common heat sources that can worsen melasma:
- Exercise, particularly hot yoga, running, or cycling in warm weather
- Saunas and steam rooms
- Cooking over a stove
- Hot showers (particularly with the face in the direct stream)
- LED face masks and certain laser or light-based devices that generate heat
This doesn't mean you need to avoid all warmth forever. But it does explain why some people see melasma flare even during winter, or why rigorous SPF use alone doesn't always keep it under control.
Why Does Melasma Keep Coming Back?
This is the question that frustrates people most. And the honest answer is that melasma is, at its core, a chronic condition that has a nasty habit of coming back.
When people stop treatment, even after achieving excellent results, melasma returns remarkably quickly. Studies show that around 72% of people who stop treatment without a maintenance plan relapse within two months. Even with a structured maintenance programme after clearance, around half of patients experience some return of pigmentation within six months.
Why so fast? Because the triggers don't disappear when you stop treating:
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Hormones continue cycling (or continue at a raised level if you're still on the pill)
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UV exposure continues every time you step outside unless you are uber diligent with sunscreen and a hat.
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Heat continues whenever you exercise, cook, or sit in a warm environment
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Genetic susceptibility is permanent. Your melanocytes never lose their tendency to overreact
This StatPearls clinical summary puts it clearly: "Patient education should emphasize that melasma is chronic and relapse-prone, with long-term outcomes dependent on consistent photoprotection and maintenance therapy rather than short-term treatment bursts.”
What this means practically: maintenance is not optional. Finishing a course of treatment and putting the skincare away is almost always the fastest route back to where you started.
Can Melasma Ever Be Cured?
Directly: no, not currently. There is no treatment that permanently eliminates melasma for most people.
What treatment can do is significantly improve its appearance, sometimes to the point where it's barely visible. And a well-maintained regimen can keep it that way for years. But the underlying tendency of melanocytes to overproduce pigment in response to hormones, UV, and heat doesn't go away. Which means the risk of recurrence remains.
There are exceptions. Melasma triggered specifically by pregnancy (sometimes called chloasma gravidarum) or by a particular hormonal medication sometimes resolves substantially once the hormonal trigger is removed — though not always, and not permanently.
For most people, the more useful way to think about melasma is: it can be managed very effectively, but it requires ongoing effort. The goal shifts from "cure" to "control." But with the right approach, control is very achievable.
How Do You Combat Melasma?
Effective melasma management works on several levels simultaneously: reducing existing pigmentation, slowing new pigment formation, and protecting against ongoing triggers.
Sun Protection - the Absolute Foundation
Daily broad-spectrum SPF product is non-negotiable. Full stop. Without consistent, daily sun protection, nothing else in a melasma regimen works as it should. Because UV exposure actively undoes the work of every active ingredient you're using. This means every single morning, rain or shine, year-round. Not just beach days.
Zinc oxide-based sunscreens offer superior broad-spectrum UVA protection as a standalone filter, and tinted formulations containing iron oxide can provide additional protection against visible light, which is particularly relevant for people with Fitzpatrick types III–VI.
Zinc Shade is a lightweight matte day cream and primer. Its non-greasy, matte finish allows for smooth application and works well under makeup. We spent countless iterations perfecting this lightweight, non-greasy formula to avoid the typical white cast and thick feel of zinc products. The results? A matte finish that works beautifully under makeup. With well tolerated matte finish, it's also well suited to irritable and blemish and bump prone skin. With SPF 15 it also provides broad-spectrum sun protection against UVA and UVB rays. Key features: Lightweight, matte formula suitable for daily use Smooth application with minimal white cast Broad-spectrum UV protection Tested SPF 15 with enhanced UVA coverage Usage: Apply evenly to all exposed areas of skin before sun exposure. Reapply as needed throughout the day.
Zinc Shade
Inhibit Melanin Production
Use ingredients that target tyrosinase, the enzyme that initiates melanin synthesis form the core of active melasma treatment.
4-n-Butylresorcinol is one of the most potent tyrosinase inhibitors available without prescription. In head-to-head biochemical testing, it significantly outperformed hydroquinone, arbutin, and kojic acid in inhibiting human tyrosinase activity, while remaining well-tolerated clinically.
Meet your new secret weapon against uneven skin tone. Enlighten Gold is a lightweight moisturiser designed to help reduce the appearance of pigmentation. We've blended high strength 4nB (a gentle, and highly effective pigmentation fighter) with PHAs (think of them as a soft exfoliant that plays nice with sensitive skin) and niacinamide to support your skin’s barrier to effectively improve your skin. Whether your skin is oily, dry, or somewhere in between, this pigmentation moisturiser fits right in. Why you'll love it: For best results, use Enlighten Gold in the morning and Ultimate A Gold at night (available together in our Golden Duo). This AM/PM approach targets pigmentation while supporting long-term skin change.
Enlighten Gold
Azelaic acid (15–20%) is another option with good evidence for melasma, including a useful anti-inflammatory action that helps address one of melasma's underlying drivers.
Vitamin C inhibits tyrosinase via a different mechanism. It works by interacting with the copper ions at the enzyme's active site, as well as giving antioxidant protection against UV-generated free radicals that would otherwise keep activating melanocytes.
C Forte Morning Serum is packed with 16% L-ascorbic acid, the purest form of Vitamin C, combined with vitamin E and ferulic acid for maximum results. Vitamin C (Ascorbic Acid) is an anti-oxidant helping neutralise free radicals (associated with exposure to the sun). The result? A brighter, firmer, plumper looking skin with fewer fine lines apparent and a more even skin tone. Formulated at the ideal pH (2.5-3.5) and housed in airless, opaque packaging, C Forte ensures stability and effectiveness, delivering radiant skin with every use.
C Forte
Featuring;
- Evidence based ingredients and formulations for superior efficacy.
- Potent skin brightening ingredients
- A plumper, more hydrated and even toned skin.
Note: C Forte can exacerbate acne and may be too strong for irritable skin.
Tranexamic acid (oral or topical) is emerging as a really effective treatment for melasma specifically. It works by interrupting the signalling pathway between keratinocytes and melanocytes that drives excessive pigment production. Oral tranexamic acid at 500–1500mg a day has shown meaningful reduction in melasma severity scores in controlled trials.
Reduce Melanin Transfer
Niacinamide reduces the transfer of melanosomes (melanin packages) from melanocytes to keratinocytes by 35–68% in co-culture models, and has demonstrated clinically meaningful improvements in facial pigmentation from only 4 weeks of use. It's also anti-inflammatory and barrier-supportive, making it a good option for sensitive or reactive skin.
Shop ESK Niacinamide Collection
Repair + is a moisturiser formulated to support skin hydration and barrier function. Its combination of niacinamide, panthenol, hyaluronic acid, and ceramides is designed to help maintain skin moisture, strengthen the barrier function of the skin, reduce the appearance of redness, and support overall skin texture. Key Features:
Repair +
Support Skin Renewal
Accelerating the shedding of pigmented skin cells helps clear existing melanin from the surface. Retinal is particularly effective here. It supports keratinocyte turnover and also acts on melanocyte activity itself, without the cytotoxicity of some stronger prescription alternatives.
The game-changing night cream developed in partnership with Selma Blair - combines our most potent hero ingredients to effectively and gently tackle the most common skin concerns – in one product. Tackling the signs of aging skin including fine lines, skin elasticity, impaired barrier function, hydration, dullness and uneven skin tone. it is our most powerful product yet and yet it’s still ridiculously well tolerated. Wake up to skin that's supple, smoother, and softer. For the most irritable of skin, Ultimate A may be a better option, particularly when starting to use Retinal based products
Ultimate A Gold
Ultimate A Gold: the most effective and gentle ingredients that evidence based cosmeceutical skincare has to offer, in one revolutionary formula.
*Ultimate A Gold (Retinal) may transfer onto white or light-coloured fabrics. For best results, we recommend using darker clothing or surfaces to avoid visible marks.
Exfoliating hydroxyacids (AHAs, PHAs) can also support cell turnover. But AHAs should be used cautiously in melasma. Over-exfoliation causes inflammation, which can worsen pigmentation rather than improve it. PHAs are gentler and better for any inflammatory skin concern.
Introducing our breakthrough skincare solution, the Gentle Glow PHA Serum, designed specifically for those with irritable, red or dry skin! - Reduces the appearance of fine lines and wrinkles and the apparent size of pores. - Helps tackle blemishes and is appropriate for irritable and red skin.
Gentle Glow PHA Serum
Harnessing the power of Polyhydroxy Acids (PHAs), which gently exfoliate and smooth the skin's surface, act as antioxidants and hydrate the skin. Unlike most exfoliation agents, PHAs are very gentle and are not only tolerated on irritable skin, but may also reduce potential irritation from other products in your skincare regimen!
Embrace the journey to a luminous, glowing complexion with the Gentle Glow PHA Serum.
- Smooths, hydrates and plumps the skin.
Professional Options
For melasma that isn't responding adequately to topical treatment, professional options include:
- Chemical peels: superficial only- medium and deep peels risk triggering PIH (post-inflammatory hyperpigmentation), especially in deeper skin tones
- Low-fluence laser treatments: Q-switched Nd:YAG and picosecond lasers, used with careful settings. Having said that all lasers and procedures carry some risk of rebound pigmentation.
- Oral tranexamic acid: prescribed by a doctor, with emerging evidence for melasma specifically. Although long term compliance is pretty low in studies.
⚠️ A note of caution on heat-generating procedures: any treatment that produces significant heat (certain laser settings, high-intensity LED devices) can potentially worsen melasma through heat-induced melanogenesis, even if the treatment is intended to improve it. This is not a reason to avoid professional treatment. But it's a reason to ensure your treating clinician has experience with melasma specifically and understands the thermal considerations. And that you use skincare before and after to calm your skin barrier, reduce inflammation and target tyrosinase.
What Results Can You Realistically Expect?
Weeks 4–8: Initial improvement may become visible, particularly in superficial epidermal pigmentation. Skin may look slightly darker in the early weeks as pigment is brought to the surface during cell turnover. This is normal and typically transient.
Weeks 8–16: More meaningful improvement usually visible with consistent daily active use and rigorous sun protection.
3–6 months: Significant improvement achievable for many people; this is generally the target window for initial treatment response.
Beyond 6 months: Ongoing gradual improvement possible; maintenance therapy is important to sustain results. Without maintenance, most people see relapse within weeks to months.
Melasma with a significant dermal component (the grey-blue, deeper pigmentation) takes longer to respond than purely epidermal melasma, and may require professional treatment alongside topicals.
The most important thing to understand about the timeline: most people give up too early. It takes patience, consistency, and a willingness to think about melasma management as an ongoing routine rather than a finite course of treatment.
Conclusion
Melasma is a chronic, relapsing form of hyperpigmentation driven by a combination of hormones, UV exposure, heat, and genetics. It's not a condition you treat once and forget about. It's one you learn to manage.
That sounds more daunting than it is. With the right approach - consistent broad-spectrum sun protection, evidence-backed actives targeting melanin production and transfer, and realistic expectations around timelines - significant improvement is absolutely achievable. Many people get to a point where their melasma is barely perceptible, and maintain that with a well-established daily routine.
The goal isn't perfection. It's control, consistency, and understanding what you're dealing with well enough to keep it that way.
References
- Hormonal Crosstalk in Melasma: Unraveling the Dual Roles of Estrogen and Progesterone in Melanogenesis. PMC. 2025. PMC12652859
- Rodrigues M et al. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2015;90(5):771–773. PMC4155956
- Lyford, W. Melasma. Medscape. Updated 2026. Medscape
- Balkrishnan R et al. The effect of melasma on self-esteem: a pilot study. J Drugs Dermatol. 2006. PMC5986109
- Dovepress/CCID. New mechanistic insights of melasma. 2023. Dovepress
- Zubair R, Mujtaba G. Inhibitory effects of progestogens on the estrogen stimulation of melanocytes in vitro. Contraception. 2009. ScienceDirect
- Lim HW et al. Sunscreens and photoprotection. StatPearls. NBK537164
- Passeron T et al. New mechanistic insights of melasma: genetic predisposition and family history. CCID / PMC. 2023. PMC9936885
- Wang Y, Zhao J, Jiang L, Mu Y. The Application of Skin Care Product in Melasma Treatment. Clin Cosmet Investig Dermatol. 2021;14:1165-1171. https://doi.org/10.2147/CCID.S323748
- Valéria Campos, Célia Kalil, Luciane Zagonel, Lasers for Melasma, Dermatologic Clinics, Volume 44, Issue 3, 2026, Pages 453-462,ISSN 0733-8635. ScienceDirect
- Arellano I et al. Preventing melasma recurrence: prescribing a maintenance regimen. JAAD. 2011. PubMed 21623930
- StatPearls. Melasma. Updated 2026. NBK459271
- Kolbe L et al. 4‐n‐butylresorcinol, a highly effective tyrosinase inhibitor for the topical treatment of hyperpigmentation. J Eur Acad Dermatol Venereol. 2013;27(S1):19–23. PubMed 23205541
- Sieber MA, Hegel JK. Azelaic acid: properties and mode of action. Skin Pharmacol Physiol. 2014. AND: PMC review of azelaic acid clinical applications. PMC11512533
- Pullar JM et al. The effect of Vitamin C on melanin pigmentation: a systematic review. J Oral Maxillofac Pathol. 2020. PMC7802860
- AlJabr A et al. Tranexamic acid for hyperpigmentation disorders: a literature review. J Cosmet Dermatol. 2026. PMC12848551
- Hakozaki T et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20–31. BJD
- Mukherjee S et al. Retinoids in the treatment of skin aging. Clin Interv Aging. 2006;1(4):327–348. PubMed
This article is for informational purposes and does not constitute medical advice. Consult a GP or dermatologist for personalised guidance on managing melasma.