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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Melasma is recognised by its look, and a doctor can prescribe the creams that fade it; peels and lasers are done in person.
- What it is: a common condition that causes flat brown or grey-brown patches, usually on both sides of the face; it is not infectious, allergic or cancerous.
- Triggers: sunlight and sunbeds, pregnancy (up to 1 in 2 pregnant women are affected), the contraceptive pill and hormone replacement therapy; about 6 in 10 people with melasma have a relative with it.
- Usual course: it fades slowly with treatment, often returns with summer sun, and can fade by itself a few months after pregnancy.
- Emergency: melasma is not an emergency, but call 112 for swelling of the face, lips or tongue, or difficulty breathing after a new product.
Melasma is not urgent. A single dark spot that is raised, growing, changing shape or colour, or bleeding is not melasma and needs prompt checking for skin cancer. Blistering, swelling or raw skin after a new cream or peel needs prompt care.
Can an online doctor treat melasma?
Yes. Melasma is usually diagnosed from its appearance, which shows well on camera in daylight. The doctor confirms it, rules out other causes of dark patches, reviews triggers such as the contraceptive pill, and prescribes creams that fade the pigmentation when they are suitable. Chemical peels and lasers carry risks and are done in person by experienced specialists.
How an online consultation helps with melasma
- A clear diagnosis: Melasma, dark marks after spots or a rash, or sun spots: the doctor tells them apart.
- Triggers reviewed: The pill, hormone replacement, pregnancy plans and skincare products, one by one.
- Creams that fade it: Prescription creams used safely, for the right length of time, with sun protection.
- Keeping it away: The sunscreen and habits that stop melasma coming back each summer.
What the doctor checks in an online consultation
The doctor asks about:
- The patches: where they are, when they started, and whether they darken in summer.
- Hormones: pregnancy, plans for pregnancy, the contraceptive pill and hormone replacement therapy.
- Sun habits: time outdoors, sunscreen, hats and sunbeds.
- Skincare: scented products, peels and other treatments you have tried.
- Your health: thyroid problems and the medicines you take, including medicines for epilepsy.
- Family history: relatives with melasma.
Before the call, remove make-up and find good daylight, so the doctor can see the colour and edges of the patches.
Melasma symptoms
Melasma causes flat brown or grey-brown patches that are darker than the skin around them. The patches are not itchy or painful, but many people are upset by how they look. They usually appear on both sides of the face, most often on:
- the cheeks
- the forehead
- the upper lip
- the nose
- the chin
The most common pattern is across the middle of the face. Less often, melasma appears along the jaw, or on the forearms and other sun-exposed skin. Melasma does not turn into skin cancer. It is usually diagnosed from how it looks; occasionally a small skin sample is taken to rule out other conditions.
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| Pattern | Where |
|---|---|
| Centrofacial | Forehead, cheeks, nose and upper lip: the most common pattern, in 50 to 80% of cases |
| Malar | Cheeks and nose |
| Mandibular | Jawline and chin |
| Extrafacial | Forearms, upper arms and shoulders, on sun-exposed skin |
Types of melasma, and why some fade faster
- Epidermal: the pigment is near the surface. The patches are dark brown with sharp edges, and they usually respond well to treatment.
- Dermal: the pigment is deeper. The patches are light brown to blue-grey with blurred edges, and they respond poorly.
- Mixed: the most common type, which usually improves partly.
Melasma or something else?
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| Condition | What points to it |
|---|---|
| Melasma | Flat brown patches on both sides of the face, often linked to pregnancy, the pill or sun |
| Dark marks after inflammation | Dark patches where spots, eczema or another rash have healed |
| Sun spots (solar lentigines) | Small, well-defined brown spots on sun-damaged skin, often on the face and hands |
| Medicine-related pigmentation | Darkening after starting a medicine |
| Melanoma | A single dark spot that is changing, irregular, raised or bleeding |
What causes melasma?
The exact cause is unknown. The pigment cells in the skin are thought to make too much melanin, the pigment that gives skin its colour. It is more common in women, usually starts between the ages of 20 and 40, and is more common in people with olive or brown skin or skin that tans quickly. Men can get it too. Up to half of pregnant women may be affected, and about 6 in 10 people with melasma have relatives with it. Overall, about 1 in 100 people have melasma. Triggers include:
- sunlight and sunbeds: both ultraviolet and visible light increase pigment, and visible light passes through windows, so melasma can darken while you drive or sit by a window
- pregnancy, when it is sometimes called the mask of pregnancy or chloasma
- hormonal medicines, such as the contraceptive pill, hormonal coils and implants, and hormone replacement therapy, which play a part in about a quarter of affected women
- scented skincare products that react with sunlight
- rarely, thyroid problems or some medicines for epilepsy
Melasma often runs in families, but it is not inherited directly, and it is not infectious, allergic or cancerous. It is usually worse in summer and better in winter. Strong blue light may play a part, but there is no evidence that the light from phones and screens affects the skin.
Which melasma treatment might the doctor recommend?
Every plan starts with sun protection, because treatment does not work without it. This is the framework the doctors use, in line with dermatology guidance.
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Mild patches | Daily broad-spectrum sunscreen with iron oxides, and camouflage | Yes | Not usually needed |
| Patches that bother you | A prescription cream such as hydroquinone, or a combination cream | Yes | Not usually needed |
| Melasma in pregnancy | Sun protection and camouflage; it may fade after the birth | Yes | Not usually needed |
| Melasma on the pill or HRT | A review of the hormonal medicine | Yes | Not usually needed |
| Not responding to creams | A dermatologist’s review: tranexamic acid, peels or lasers | Yes, to assess | For peels and lasers |
Dark patches on your face? A doctor can confirm what they are and plan treatment in one consultation.
See available times →Treatment options for melasma
What you can do yourself
- Use a broad-spectrum sunscreen of SPF 30 or higher with a high UVA rating every day, all year round; a tinted sunscreen with iron oxides also blocks visible light. Dermatologists often recommend sunscreens with zinc oxide, titanium dioxide or iron oxide.
- Choose a water-resistant one, apply it a quarter of an hour before going outside, and reapply at least every 2 hours.
- Wear a broad-brimmed hat and sunglasses, seek shade, and avoid sunbeds and sunlamps.
- Use gentle, fragrance-free skincare. If a product burns or stings, it is irritating your skin: stop using it.
- Use camouflage make-up, a thick colour-matched cream, to cover the patches if you want to.
Prescription treatment
A prescription is never issued without a consultation. Hydroquinone cream reduces melanin; it is used for a few weeks at a time, under medical supervision, and avoided in pregnancy. Combination creams that contain hydroquinone, a retinoid and a mild steroid work best for many people, improving melasma in about 60 to 80%. Azelaic acid is another option. Tranexamic acid, as a cream or tablets, can help some people. Improvement is slow, over months. If the doctor prescribes, use the prescription at a pharmacy near you.
Other creams that can help
Other ingredients can help lighten melasma: azelaic acid, vitamin C, kojic acid, cysteamine and thiamidol. Skin-lightening creams should only be used under medical supervision, and only alongside daily sun protection.
Peels and lasers
Chemical peels, microneedling and lasers can help, but they can make pigmentation worse or cause scarring, so they should only be done by experienced specialists, usually after a course of cream.
What does not help
Treatment works poorly without daily sun protection, and sun exposure brings the pigmentation back. Scented skincare products can react with sunlight and trigger more pigmentation.
Does melasma go away?
Sometimes, but it often comes back. There is no cure, but melasma can be controlled. Melasma that starts in pregnancy may fade a few months after the birth without treatment, though it can return in later pregnancies. Stopping a hormonal trigger, such as the pill, can help. With treatment, it usually takes 3 to 12 months to see results, and longer when melasma has been there for years or the pigment is deep. Melasma often returns when treatment stops or with summer sun, so lifelong sun protection keeps improvements going.
If you avoid the sun carefully, ask the doctor whether you need a vitamin D supplement.
Special situations
Pregnancy and breastfeeding
Sun protection and camouflage are safe in pregnancy. Hydroquinone and retinoid creams are avoided, and most other lightening creams wait until after the birth, when melasma may fade by itself. Azelaic acid is one of the few creams that may be used in pregnancy: check with the doctor first.
The contraceptive pill and hormone replacement therapy
Stopping hormonal contraception can help where possible, but do not stop a medicine without advice: the doctor can talk through other options.
Summer and sunny holidays
Strong summer sun can bring pigmentation back even after good results, so a sunny holiday needs extra care. Pack a tinted, water-resistant sunscreen and a wide-brimmed hat, reapply sunscreen through the day, and seek shade when the sun is strongest.
Brown and black skin
Melasma is more common on brown skin. Peels and lasers can leave darker marks, so treatment is cautious and creams come first.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When melasma is treated online, and when you need in-person care
Treated online: diagnosis of typical melasma, sun protection and camouflage advice, prescription creams, reviews of hormonal triggers, and follow-up of how treatment is working.
In-person care: chemical peels, microneedling and lasers, specialist treatment when creams have not helped, and any dark spot that is raised, changing or bleeding.
When to get in-person care
Call 112 or go to an emergency department now for:
- swelling of the face, lips or tongue, or difficulty breathing after a new product or medicine
Get medical advice the same day for:
- blistering, swelling or raw, weeping skin after a new cream or a peel
- a burn after a laser or peel that is getting more painful, or oozing pus
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about melasma: show the patches on camera in daylight without make-up, and mention pregnancy plans and hormonal medicines.
- Leave with a plan: what to do, what to use and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s melasma? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
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Similar symptoms, different condition? Pityriasis versicolor can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about melasma
What is melasma?
Melasma is a common condition that causes flat brown or grey-brown patches, usually on the cheeks, forehead, upper lip, nose and chin. It is not infectious, allergic or cancerous.
Is it melasma or something else?
Melasma is flat, symmetrical brown patches with ragged edges on the cheeks, forehead or upper lip that darken in summer. Post-inflammatory marks follow acne or a rash and sit where the spots were; solar lentigines are small, separate, well-defined sun spots on sun-exposed skin; a café-au-lait patch has been there since childhood; and a raised, changing or single dark patch needs an in-person check to rule out skin cancer. The doctor tells them apart on camera.
What is the main cause of melasma?
The pigment cells make too much melanin. Sunlight and hormones trigger it: pregnancy, the contraceptive pill and hormone replacement therapy. About 6 in 10 people with melasma have relatives with it.
Can melasma become cancerous?
No. Melasma does not turn into skin cancer. A single dark spot that is raised, growing, changing or bleeding is something else and needs checking for skin cancer.
Does melasma go away after pregnancy?
Often, partly. Melasma that appeared in pregnancy, sometimes called the mask of pregnancy, may fade a few months after the birth as hormone levels settle, without treatment, but it frequently returns in later pregnancies, with the contraceptive pill or after a summer in the sun. Strict sunscreen during and after pregnancy improves the chance it fades, and creams can be started after breastfeeding.
How long does melasma treatment take to work?
Usually 3 to 12 months, and longer if melasma has been there for years. Patches with pigment near the surface fade faster than deep, blue-grey patches.
Which skincare ingredients help melasma?
For melasma, daily tinted sunscreen with iron oxides comes first. Azelaic acid, vitamin C, kojic acid, cysteamine and thiamidol can help a little, and gentle, fragrance-free products avoid irritation.
What can I do at home for melasma?
Wear a tinted broad-spectrum SPF 50 sunscreen every day and reapply it outdoors, add a wide-brimmed hat and sunglasses, avoid the midday sun and sunbeds, stop any scented or harsh skincare that irritates the skin, use gentle cleansers and a moisturiser, consider over-the-counter azelaic acid, vitamin C or niacinamide, never pick or scrub the patches, and ask about switching from the contraceptive pill if it is a trigger. Home care alone fades melasma slowly; it mainly stops it darkening.
Can melasma be prevented?
Not entirely, because hormones and skin type play a part, but most melasma is sun-driven: daily tinted sunscreen from spring onwards, a hat, shade, no sunbeds, and starting sunscreen as soon as a pregnancy is confirmed prevent a large share of new patches and most recurrences. Choosing a non-hormonal contraceptive if the pill triggered melasma, and avoiding skin irritation, waxing and heat treatments on the face, also help.
What is the best treatment for melasma?
Daily broad-spectrum sunscreen, ideally tinted with iron oxides to block visible light, is the foundation of every melasma treatment. On top of that, prescription creams, especially a combination of hydroquinone, a retinoid and a mild steroid used for a few months, improve melasma in most people, with azelaic acid or tranexamic acid as alternatives; peels and lasers are reserved for specialists because they can make it worse.
Which sunscreen is best for melasma?
A broad-spectrum sunscreen of SPF 30 or higher with a high UVA rating, used every day. A tinted sunscreen with iron oxides also blocks visible light, which can darken melasma.
Can I use hydroquinone in pregnancy?
No. Hydroquinone and retinoid creams are avoided in pregnancy and while breastfeeding. Strict sun protection with a tinted mineral sunscreen, a wide-brimmed hat, azelaic acid, which is considered safe, and camouflage make-up are the options until the baby is born, and pregnancy melasma often fades by itself in the months after the birth, when the stronger creams can be started.
Can lasers or peels remove melasma?
They can help some people with melasma, but they can make pigmentation worse or cause scarring, so they are only done by experienced specialists, usually after creams.
Why does my melasma come back every summer?
Sunlight, including visible light and heat, stimulates the pigment cells, so melasma returns in summer and whenever treatment stops; most people need a tinted broad-spectrum sunscreen every day of the year, reapplied every two hours outdoors, a hat, shade in the middle of the day, and a maintenance cream through the winter to keep the patches from building up again.
Can an online doctor treat melasma?
Yes, usually. A doctor can recognise melasma on camera, review your triggers such as the contraceptive pill or pregnancy, and prescribe the fading creams, with the prescription usable at a pharmacy near you and never issued without a consultation. Peels and lasers are done in person, and a patch that is uneven, raised or changing is checked in person too.
- Melasma, British Association of Dermatologists patient information leaflet, updated June 2024.
- Melasma, DermNet, New Zealand, updated December 2025.
- Melasma, British Skin Foundation, accessed 15 October 2026.
- Melasma: what are the best treatments?, Harvard Health Publishing, Harvard Medical School, 11 July 2022.
- Melasma: diagnosis and treatment, American Academy of Dermatology, updated 15 February 2022.
- Melasma: self-care, American Academy of Dermatology, updated 12 September 2023.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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