Melasma & Hyperpigmentation

Hyperpigmentation is a general term for areas of the skin that are darker than a person’s natural skin tone. It occurs when melanocytes, the skin cells that produce melanin, become overactive, leading to discoloration in the form of dark spots or patches. Types of hyperpigmentation include sun spots, freckles, post-inflammatory hyperpigmentation (PIH), and melasma. Although these conditions are harmless, their appearance can cause self-consciousness and make the skin look prematurely aged, prompting many patients to seek professional treatment from an experienced, board-certified dermatologist such as Dr. Michele Green in New York City.

Melasma is a common, persistent form of hyperpigmentation characterized by dark brown or gray patches that typically appear symmetrically on the face — especially on the upper lip, forehead, and cheeks — and are often triggered or worsened by sun exposure, hormonal changes, and genetics. Because melasma requires different treatment options than other types of hyperpigmentation, such as sun spots and PIH, an accurate diagnosis is essential before beginning any treatment plan. While sun spots and certain other forms of discoloration can be treated with laser therapy or intense pulsed light (IPL), melasma must be approached more carefully — with chemical peels, microneedling, and targeted skin care products — to avoid worsening the condition. With the right combination of in-office procedures and specially formulated skin care products with Dr. Green, it is possible to reduce pigmentation and prevent its recurrence.

Dr. Michele Green is an expert in treating Dr. Michele Green is an expert in treating sunspots, melasma, and discoloration at her private practice on the Upper East Side of NYC. A board-certified dermatologist with over 25 years of experience, Dr. Green specializes in removing sunspots and facial hyperpigmentation while staying at the forefront of safe, effective treatments. Castle Connolly, New York Magazine, Super Doctors, and The New York Times regularly recognize Dr. Green as one of NYC’s top dermatologists for her dedication to patients and expertise. Dr. Green takes a holistic approach and follows a less-is-more philosophy for facial rejuvenation. She will help you achieve and maintain even, beautiful, and clear skin by creating a personalized treatment plan that includes the best options, skincare, and broad-spectrum sunscreen.

What is hyperpigmentation?

Hyperpigmentation is a broad term for any skin discoloration darker than the natural skin tone. It occurs when melanocytes — the skin cells that produce melanin, the pigment responsible for skin color — become more active. The main cause of hyperpigmentation is excessive sun exposure. Harmful ultraviolet (UV) rays from the sun can stimulate melanin production, resulting in dark spots or patches on the skin. Genetics can also play a role, as some individuals may have more melanocytes or a genetic tendency to produce excess melanin. Certain medications, such as oral antibiotics and specific antipsychotics, can make the skin more sensitive to sunlight and lead to hyperpigmentation. This condition can affect people of all ages, skin tones, and types. Although hyperpigmentation is harmless, many individuals seek treatment for cosmetic reasons.

What is melasma?

Melasma is a common skin condition characterized by light brown, dark brown, or gray-brown patches that are darker than the surrounding skin. This type of hyperpigmentation usually appears on the face — especially on the upper lip, forehead, bridge of the nose, and cheeks — and is often symmetrical. Melasma can also develop on the body, mainly in areas regularly exposed to the sun, such as the forearms, neck, and shoulders. While it is hard to predict when melasma will first appear, it is more common during the reproductive years and rarely occurs before puberty. This condition affects women more than men, especially those between 20 and 40 years old, due to natural hormonal changes. Melasma is also more common in medium to darker skin tones, including individuals of Asian, Hispanic, and African descent, because these skin types have a higher density of melanocytes.

Melasma is harmless and does not cause symptoms such as itching, burning, or pain. However, skin discoloration and pigmentation changes can be distressing for many people. Additionally, melasma can be difficult to distinguish from other types of hyperpigmentation, making an accurate diagnosis essential for effective treatment. It is recommended to consult a board-certified dermatologist, such as Dr. Green, to ensure the safest and most effective melasma treatment.

Other Forms of Hyperpigmentation

Sun spots, also called age spots, liver spots, and solar lentigines, are flat brown patches that vary in size and shape and appear on sun-exposed areas of the skin, such as the face, shoulders, arms, and hands. These spots often become more noticeable with age.

Freckles are small brown spots that usually appear on areas frequently exposed to sunlight, such as the face. UV rays from the sun trigger the skin to produce melanin as a protective response, leading to small, flat brown spots. The most common type of freckle, ephelides, is the one most people think of when they hear the word “freckles.”

Post-inflammatory hyperpigmentation (PIH) is a form of hyperpigmentation characterized by dark spots that persist after a scar, injury, acne lesion, or other inflammatory skin conditions, including dermatitis, eczema, and psoriasis. During the skin’s natural healing process, inflammation can stimulate excess melanin production, leading to hyperpigmentation in the affected area. These dark patches can vary in color, ranging from brown to black. PIH can also develop after improper laser treatments. Although it may fade on its own, many patients seek treatment from Dr. Green to achieve brighter, clearer skin more quickly.

What causes melasma?

Melasma occurs when melanocytes in the epidermal or dermal layers of the skin produce excessive melanin. Although the exact cause of the overactive melanocytes is unknown, several risk factors can trigger or worsen melasma.

Sun exposure — UV rays from the sun stimulate melanocytes to produce melanin as a skin defense, which can worsen or trigger melasma. UV radiation from tanning beds can also worsen its appearance. It is essential for anyone with melasma to apply broad-spectrum sunscreen with SPF 50 or higher daily and to avoid unnecessary UV exposure. Sun exposure can even cause previously treated melasma to return.

Hormonal changes — Birth control pills, oral contraceptives, pregnancy, and hormone replacement therapy are commonly known to trigger melasma. In fact, melasma is often called chloasma or the “mask of pregnancy” because of this. The onset of melasma due to hormonal changes is associated with elevated levels of female sex hormones, such as estrogen and progesterone. As these hormone levels increase, melanocytes multiply and become more sensitive to UV rays. Pregnant women or those taking hormonal medications often find that their melasma fades after giving birth or stopping the medications.

Genetics — People with a family history of melasma are more likely to develop it. Additionally, identical twins often show similar melasma symptoms, further suggesting that genetics plays a significant role.

Thyroid disease — Melasma and thyroid disorders may be linked, as the prevalence of thyroid disease is four times higher in patients with melasma than in the general population. However, more detailed clinical studies are needed to confirm a definitive connection.

Medications — Certain oral antibiotics, cardiac medications, and other photosensitizing drugs can trigger or worsen melasma. These include nonsteroidal anti-inflammatory drugs, antipsychotics, antiseizure medications, hormonal therapies, and some topical agents.

What is the difference between melasma and hyperpigmentation?

Melasma is a specific type of hyperpigmentation characterized by dark brown or gray patches on the skin, usually appearing symmetrically on the face. While the exact cause of melasma is unknown, risk factors include sun exposure, tanning beds, hormonal changes (such as pregnancy and oral contraceptive use), specific medications, skin tone, genetics, and thyroid disease. Hyperpigmentation, on the other hand, is a broader term referring to any skin condition that causes discoloration darker than the surrounding skin tone. Other types of hyperpigmentation include sun spots, freckles, and post-inflammatory hyperpigmentation.

A key distinction between melasma and other types of hyperpigmentation is how each responds to treatment. Laser therapy using devices such as Fraxel, AlexTrivantage, and Intense Pulsed Light (IPL) is often effective for sun spots and age spots, but should be avoided for melasma. The heat generated by these lasers can cause pigment to penetrate deeper into the layers of skin, worsening the condition. Cosmelan peels, Mesopeels, microneedling, and specific skin care ingredients tend to be more effective and safer for treating melasma. Dr. Green’s expertise in dermatology allows her to accurately distinguish between melasma, sun spots, and other forms of hyperpigmentation during a straightforward physical exam, ensuring each patient receives the right treatment plan.

Do I have melasma or hyperpigmentation?

The best way to understand your skin condition is to schedule a consultation with an experienced, board-certified dermatologist such as Dr. Michele Green in New York City. Identifying which type or combination of hyperpigmentation you have can be difficult without help from a trained medical professional. Dr. Green is an internationally recognized authority in cosmetic dermatology, with over 25 years of experience. During your consultation, she will gather a complete medical and family history, perform a physical assessment of your skin, and review any previous cosmetic procedures or treatments. She will then develop a personalized treatment plan that targets your unique skin concerns and provides natural-looking, long-lasting results.

The Best Treatments for Melasma & Hyperpigmentation

No single treatment is inherently the “best” for melasma and hyperpigmentation — each patient’s plan depends on their skin type, skin tone, and the nature and severity of their skin concerns. Melasma is most effectively managed with chemical peels and microneedling, which consistently deliver impressive results with minimal risk of side effects. Sunspots and other forms of hyperpigmentation can also be treated with certain resurfacing lasers. However, patients with darker skin tones are generally better suited for chemical peels, as some lasers can mistake darker skin for pigmented areas. Dr. Green will help you develop a personalized plan tailored to your specific needs.

Chemical Peels

Chemical peels are a safe and effective cosmetic treatment for melasma and hyperpigmentation. One option Dr. Green offers is the trichloroacetic acid (TCA) peel, available in various strengths, which removes the outer layers of the epidermis to exfoliate dead, discolored skin cells, promote skin cell renewal, and reveal a healthier, brighter complexion. TCA peels also boost collagen production and help with sun damage, fine lines, and uneven skin tone. Multiple sessions are typically recommended. Note that TCA peels are generally not advised for patients with darker skin tones due to an increased risk of adverse effects; in such cases, other peel options, such as Cosmelan or Mesopeel, are preferred.

Mesopeels for skin lightening

Mesopeels are specially formulated chemical peels by Mesoestetic that gently yet effectively target skin discoloration, dark spots, and photoaging. Their formulation includes active skin-lightening ingredients that regulate melanocyte activity and chemical exfoliants that accelerate skin cell turnover. Mesopeels can be applied to both the face and the body and are safe for all skin types and tones, including those with darker skin tones. A series of treatments is typically recommended for optimal results.

Cosmelan Peel to treat melasma and hyperpigmentation

The Cosmelan peel is a medical-grade chemical treatment designed to address melasma and other types of hyperpigmentation. It speeds epidermal renewal to remove excess melanin, blocks pigment migration within the skin, and decreases melanin production in melanocytes. Dr. Green begins the procedure by professionally applying the Cosmelan 1 mask, which remains on for a time she determines based on skin tone and discoloration severity. The patient then gently removes it at home with a mild cleanser. Patients are recommended to use the Cosmelan home kit — including the Cosmelan 2 depigmentation cream, a hydrating moisturizer, and a broad-spectrum sunscreen — to support and prolong results. A follow-up appointment at four weeks allows Dr. Green to review progress and adjust the treatment plan as needed. Cosmelan delivers highly effective, long-lasting results with minimal downtime.

Microneedling for melasma and hyperpigmentation

Microneedling, also called collagen induction therapy, is a non-invasive skin rejuvenation treatment in which a handheld device with tiny needles creates micro-injuries in the outer layers of the skin. These micro-injuries boost collagen production and speed up skin cell turnover, improving the appearance of discoloration, fine lines, wrinkles, acne scarring, stretch marks, enlarged pores, and uneven skin tone. The microchannels created also enhance the absorption of specialized serums. For patients primarily concerned with melasma and hyperpigmentation, combining microneedling with a depigmenting serum — containing powerful yet gentle skin-brightening agents that block melanocyte activity — delivers excellent results. Patients report that their skin looks more radiant and maintains a healthy glow for an extended period following treatment.

HydraFacials to reduce facial pigmentation and discoloration

A HydraFacial is a three-step treatment that cleanses, exfoliates, and nourishes the skin to produce a clearer, brighter complexion. Its patented vortex technology enables active ingredients to penetrate deeply into the pores. The treatment can be customized with boosters targeting specific skin concerns, such as melasma, hyperpigmentation, acne, dullness, and aging. The Murad Vita-C booster contains vitamin C, tranexamic acid, glycolic acid, and Murad’s proprietary RepleniCell molecule, which brightens and hydrates the skin. The Britenol booster features vitamin C and alpha-arbutin to reduce hyperpigmentation and protect against oxidative stress.

VBeam laser for post-inflammatory hyperpigmentation and melasma

The VBeam laser is a pulsed dye treatment designed to target facial redness, broken capillaries, and spider veins. It is also effective at reducing redness and inflammation associated with post-inflammatory hyperpigmentation and melasma. Unlike other lasers that generate heat that can worsen melasma, the VBeam emits bursts of light at 595 nanometers, specifically targeting variations in the skin’s red pigment rather than stimulating deeper melanocyte activity, making it a safe exception to the general caution against laser therapy for melasma. The treatment is safe and effective for patients of all skin types and tones, with no downtime. Typically, 4 to 6 sessions spaced 1 month apart can significantly reduce inflammation associated with melasma and other forms of hyperpigmentation.

Laser treatments for hyperpigmentation that are not suited for melasma

While laser therapy is highly effective for certain types of hyperpigmentation, melasma is a notable exception. Laser treatments work by emitting concentrated beams of light that generate heat within the skin, effectively targeting and reducing superficial pigmentation such as sun spots and age spots. However, in the case of melasma, heat may trigger inflammation that prompts melanocytes to overproduce melanin — worsening the condition rather than improving it. For this reason, Dr. Green specifically warns against standard laser treatments for melasma and prefers topical treatments, chemical peels, and other methods that target pigmentation without increasing the risk of complications.

Fraxel laser for sun damage and hyperpigmentation

The Fraxel laser is a resurfacing treatment that Dr. Green often calls the “magic eraser” for its ability to address a range of skin concerns. It has two wavelengths: 1927nm, best for treating hyperpigmentation and sun spots, and 1550nm, which targets wrinkles, stretch marks, and acne scars. The laser creates controlled micro-wounds in the skin, stimulating new collagen production and generating new skin cells. When set to 1927nm, Fraxel effectively reduces dark sun spots on the face, neck, chest, arms, and legs. There is minimal downtime, with mild redness and swelling for about 48 hours, and some peeling with a rough, sandpaper-like texture for 3 to 5 days. A series of treatments spaced one month apart is recommended to achieve a more even skin tone. This laser is suited for sun damage and hyperpigmentation — not for melasma.

AlexTrivantage for sun spots and age spots

Candela’s AlexTrivantage laser targets and removes sun spots and age spots by delivering a specific wavelength of light that is absorbed by melanin in the dark spots. The light energy converts to heat, breaking down and destroying pigmentation while leaving the surrounding tissue unharmed. The AlexTrivantage laser is also effective for treating unwanted birthmarks and pigmented tattoos. Many patients see noticeable results after just 1 to 2 sessions, and downtime is minimal.

Clear + Brilliant laser for discoloration

The Clear + Brilliant laser — often called the “mini-Fraxel” — is a resurfacing treatment that uses fractionated laser technology to create millions of tiny treatment zones, stimulating new collagen production and replacing damaged skin cells. The Permea handpiece is specifically designed to eliminate facial pigmentation in 4 to 6 sessions. In addition to targeting discoloration, the Clear + Brilliant laser also addresses fine lines, wrinkles, enlarged pores, and mild acne scars, leaving patients with a more even skin tone and smoother texture.

What are the best topical treatment products to use for facial melasma and hyperpigmentation?

A proper skin care routine is crucial for anyone with melasma and hyperpigmentation, both to maintain the effects of cosmetic treatments and to prevent recurrence. During your consultation with Dr. Green, she will tailor a personalized skin care plan incorporating the best topical treatments to diminish hyperpigmentation and promote clear, glowing skin. Dr. Green created her own unique skincare line, MGSKINLABs, specifically designed to address skin conditions such as melasma and hyperpigmentation.

Sunscreen is crucial in any skin care routine, particularly for patients with hyperpigmentation and melasma. UV rays stimulate melanocytes to produce melanin, which can trigger or worsen melasma and cause sun spots or age spots. It is vital to apply a broad-spectrum sunscreen with an SPF of 50 or higher daily to shield against both UVA and UVB rays, reapplying every 90 minutes or after water exposure. Dr. Green also suggests that patients with melasma use both chemical and physical sunscreens for optimal sun protection. Chemical sunscreens contain ingredients like oxybenzone or avobenzone, which convert harmful UV rays into harmless heat. Physical sunscreens contain zinc oxide or titanium dioxide to create a protective barrier on the skin. Some sunscreens also include iron oxide to block visible light, providing an extra layer of protection, particularly relevant for melasma patients. The Hydrating SPF 50 from MGSKINLABs is an excellent physical sunscreen with zinc oxide for UV defense, along with hyaluronic acid and lactic acid to hydrate and soften the skin.

Hydroquinone is a skin lightening ingredient that inhibits melanin production, reducing hyperpigmentation and melasma. Hydroquinone creams are available only by prescription from a board-certified dermatologist such as Dr. Green, and vary in strength from 4% to 10% depending on skin type and severity. It is not intended for long-term use, and patients should follow up regularly with Dr. Green to adjust their skin care plan. It is also important to use proper sun protection when using hydroquinone, as it increases skin sensitivity to sunlight.

Retinoids and retinol are topical derivatives of vitamin A that boost skin cell turnover, removing discolored, dead skin cells and helping healthy new cells reach the surface more quickly. MGSKINLABs offers the Essential Antioxidant Infusion, a gentle yet effective retinol designed to speed skin cell renewal and promote a more even skin tone. Patients with moderate to severe hyperpigmentation can obtain a prescription retinoid, such as tretinoin (Retin-A), from Dr. Green. Some retinoids are combined with corticosteroids to enhance effectiveness — the Kligman Formula, for instance, combines tretinoin with a low-dose corticosteroid cream to reduce post-inflammatory hyperpigmentation. Sunscreen should always be used alongside retinoids, as they increase photosensitivity.

Vitamin C is a powerful antioxidant that improves skin tone and texture. It neutralizes harmful free radicals and fights oxidative stress, which can cause premature aging and various skin issues. Dr. Green’s MGSKINLABs Vita-C Serum is formulated with a high concentration of vitamin C to promote skin cell renewal and collagen production, reducing dark spots and enhancing overall skin appearance.

Other effective skin-lightening ingredients include tranexamic acid, azelaic acid, cysteamine, kojic acid, and glycolic acid. Tranexamic acid and azelaic acid both act as tyrosinase inhibitors, effectively decreasing melanin production to reduce existing dark spots and prevent new ones from forming. Azelaic acid also has anti-inflammatory properties, making it useful for conditions such as acne and rosacea. Cysteamine inhibits both tyrosinase and peroxidase, making it especially effective for treating pigmentation issues such as melasma. Kojic acid, a naturally derived compound, reduces excess melanin levels and provides antifungal benefits. Glycolic acid, an alpha-hydroxy acid (AHA), accelerates the skin’s cell renewal process to exfoliate discolored and dead skin cells, exposing fresher skin beneath. The Skin Brightening Cream from MGSKINLABs combines kojic acid, glycolic acid, lactic acid, and various fruit extracts into a unique formula that targets pigmented areas, revitalizes the skin’s overall radiance, and promotes a more even appearance.

Does melasma hyperpigmentation go away?

Melasma hyperpigmentation can sometimes resolve on its own, particularly when hormonal changes drive it. For example, the “mask of pregnancy” — melasma triggered by elevated estrogen and progesterone during pregnancy — often fades after childbirth as hormone levels stabilize. However, diligent sun protection remains essential during and after pregnancy, as UV exposure can cause new spots to form or worsen existing ones. For many people, melasma is a long-term skin condition that persists for years and requires ongoing management. Consulting a dermatologist provides access to additional treatment options and a customized approach that supports skin health long-term.

When should I see a dermatologist about melasma hyperpigmentation?

If you notice any signs of melasma or hyperpigmentation, it is best to see a dermatologist promptly. Early intervention can be key to managing the condition. A board-certified dermatologist will assess the type and severity of your hyperpigmentation and recommend suitable treatments tailored to your skin type and needs. It is particularly important to consult a dermatologist with extensive experience in treating melasma, since laser treatments — which may be recommended by providers less familiar with the condition — can actually worsen it by driving pigment deeper into the skin. Dr. Green’s expertise in dermatology ensures that patients receive safe, effective alternatives that minimize the risk of side effects and support long-lasting results. Additionally, if you notice new, unusual dark lesions and are unsure whether they represent hyperpigmentation or skin cancer, prompt evaluation by a board-certified dermatologist, such as Dr. Green, is essential for an accurate diagnosis.

FAQs about Melasma Hyperpigmentation

Is hyperpigmentation the same as melasma?

All melasma is a form of hyperpigmentation, but not all hyperpigmentation is melasma. Hyperpigmentation is a broad term for any skin discoloration darker than the natural skin tone, encompassing sun spots, age spots, freckles, melasma, and post-inflammatory hyperpigmentation. It most often results from excess melanin production triggered by sun exposure. Melasma, by contrast, is a distinct skin condition characterized by dark brown or gray-brown patches, triggered and worsened by specific factors including hormonal changes, birth control, certain medications, and genetics.

Telling them apart matters clinically because some treatments that work well for other types of hyperpigmentation — including certain laser therapies — can actually worsen melasma. Treating hyperpigmentation and melasma in people with darker skin tones also requires careful attention, as improper treatment can exacerbate these conditions. Dr. Green has over 25 years of experience evaluating and treating all skin types and tones, and will determine the specific type of hyperpigmentation during your appointment and create a treatment plan to help you achieve brighter, more even skin.

Is hyperpigmentation the same as skin cancer?

No, hyperpigmentation is not the same as skin cancer. Hyperpigmentation refers to benign, flat, dark spots or patches that develop due to an overproduction of melanin triggered by excessive UV radiation. Skin cancer, in contrast, involves the abnormal growth or proliferation of skin cells. Skin cancers are evaluated based on the lesion’s symmetry, irregular borders, color, size, and growth. If a lesion is concerning after evaluation, Dr. Green will perform a small biopsy and send it to a lab for further testing. If you notice any new dark or unusual lesions and are unsure whether they represent hyperpigmentation or skin cancer, it is important to see a board-certified dermatologist promptly.

Can laser treatments improve melasma hyperpigmentation?

Melasma is a type of hyperpigmentation that should not be treated with most laser procedures. Laser treatment can worsen melasma by pushing pigment deeper into the skin, making the discoloration harder to eliminate. Dr. Green prefers to manage melasma with Cosmelan peels, Mesopeels, and the VBeam laser — the latter specifically targets redness and inflammation rather than generating heat that can trigger melanocyte overactivity. She also specializes in treating patients whose melasma has worsened due to prior ablative or non-ablative laser treatments performed elsewhere.

Is melasma hyperpigmentation genetic?

Melasma often has a strong genetic component. Studies show that between 33% and 50% of people with melasma have a family history of the condition, suggesting an inherited predisposition. Its development usually involves a combination of genetic vulnerability and environmental triggers, including UV light exposure, hormonal changes often linked to pregnancy or birth control pills, and skin inflammation. This combination of factors results in the distinctive dark patches characteristic of melasma, commonly found on sun-exposed areas of the face.

Can hormonal birth control cause melasma and hyperpigmentation?

Yes, hormonal birth control can contribute to the development or worsening of melasma and hyperpigmentation. Hormones such as estrogen and progesterone, found in various forms of birth control including pills, patches, injections, and rings, can stimulate melanocytes, leading to dark patches on the skin — similar to the “mask of pregnancy.” Research shows that approximately 10–25% of people using oral contraceptives may develop melasma or experience worsening of existing hyperpigmentation. Sun exposure, genetics, and other hormonal changes can further affect the severity of these skin conditions. Patients who notice skin changes while using hormonal birth control should consult their dermatologist.

Does sunscreen help prevent or treat melasma hyperpigmentation?

Sunscreen plays a vital role in managing melasma hyperpigmentation. While it will not remove existing dark patches, it is essential in preventing them from worsening and protecting the skin against harmful UV rays. For effective sun protection, a broad-spectrum sunscreen with an SPF of 30 or higher is recommended for general skin health; patients with melasma should use SPF 50 or higher and reapply every 1.5 hours, especially outdoors. Wearing a wide-brimmed hat can provide additional protection by reducing direct sun exposure to the face. Incorporating these practices into a daily routine greatly improves long-term management of melasma.

Is melasma hyperpigmentation worse in pregnancy?

Melasma hyperpigmentation can indeed worsen during pregnancy due to increased levels of estrogen and progesterone, which stimulate greater melanin production. Hormonal changes during pregnancy may intensify pre-existing melasma or trigger it for the first time, leading to more noticeable discoloration. While melasma is generally harmless, its appearance can affect self-esteem and body image. Proper skin care and consultation with a board-certified dermatologist, such as Dr. Green — who works collaboratively with a patient’s OB-GYN — can be very helpful in managing melasma during this time.

Which acid is best for melasma and hyperpigmentation?

No single acid is the definitive best choice for melasma and hyperpigmentation — effective treatment plans often combine chemical peels and skin care products with various acids to address pigmentation from multiple angles. Trichloroacetic acid (TCA) is used in chemical peels to exfoliate gently, removing dead, pigmented skin cells. Tranexamic acid, azelaic acid, and kojic acid are topical agents that lighten the skin by inhibiting tyrosinase, an enzyme necessary for melanin production. Glycolic acid, an AHA, gently exfoliates the skin to speed cell turnover and brighten the complexion. Dr. Green will recommend the right combination based on your individual skin type and concerns.

Can melasma be reversed?

If melasma is triggered by hormonal changes — such as those during pregnancy or from birth control pills — it may fade on its own after childbirth or when stopping the medication. However, for many people, melasma is a long-term skin condition that can persist for years or even a lifetime, and over-the-counter skin care products and natural remedies may not deliver the results patients want. Dr. Green offers safe and effective melasma treatments at her New York City office, tailoring each patient’s treatment plan to their skin type and tone to reduce pigmentation and prevent recurrence.

Does melasma come back after hydroquinone?

Yes, melasma and other types of hyperpigmentation can return after treatment with hydroquinone. Hydroquinone is a skin-lightening agent that reduces the number of melanocytes and blocks melanin production, and is effective for treating melasma, acne scars, freckles, dark spots, sun spots, and age spots. However, it is not intended for long-term use, and strict sun protection is crucial to maintain results. Melasma may return after stopping hydroquinone, especially with ongoing sun exposure. Dr. Green emphasizes the importance of daily broad-spectrum sunscreen and sun-protective clothing, and may advise pausing hydroquinone use during summer months or before a sunny vacation, as it increases the skin’s sensitivity to sunlight.

What is the best way to prevent melasma and hyperpigmentation?

The most important steps to prevent melasma from worsening are avoiding direct sun exposure, applying broad-spectrum sunscreen with SPF 50 or higher daily, and wearing sun-protective clothing. Tanning beds should also be avoided, as they can worsen skin pigmentation. Sunscreen should be reapplied every 90 minutes, and after swimming or sweating, for proper protection. Wide-brimmed hats and clothing labeled with a UPF (Ultraviolet Protection Factor) rating are highly recommended. Minimizing direct sun exposure between 10 AM and 4 PM — when the sun is strongest — or taking extra precautions during these hours is advisable. Additionally, women with melasma may reduce their risk of recurrence by stopping hormonal birth control pills or switching to a non-hormonal contraceptive method. However, patients should consult their OB-GYN or prescribing provider before making any changes to their medications.

How do I get started with melasma and hyperpigmentation treatment today?

Melasma and hyperpigmentation, whether in the form of sun spots, post-inflammatory hyperpigmentation, dark patches, or other types of discoloration, can cause feelings of self-consciousness or low self-esteem. Fortunately, Dr. Green offers treatments such as Cosmelan peels, Mesopeels, Fraxel laser, AlexTrivantage laser, and microneedling to help you achieve a clear, radiant complexion, no matter the type of hyperpigmentation. The best treatment options depend on your skin tone, skin type, and the severity and type of hyperpigmentation you have. Consulting an experienced, board-certified dermatologist like Dr. Green in New York City is the fastest and safest way to understand and manage your hyperpigmentation, helping you look and feel your best.

Dr. Michele Green is an internationally recognized, board-certified cosmetic dermatologist with over 25 years of experience providing some of the most discerning men and women in New York City with the finest non-invasive treatments. Castle Connolly, New York Magazine, Super Doctors, and The New York Times consistently name Dr. Green among NYC’s top dermatologists for her commitment to her patients and her expertise. She customizes every treatment plan to address each patient’s specific concerns and aesthetic goals, helping them look and feel like the best version of themselves. To begin treating your melasma or hyperpigmentation today, schedule a consultation with Dr. Green by contacting us online or calling the NYC-based office at 212-535-3088.