Melasma causes and treatments are often a big concern for people who notice dark patches on their face, especially on the cheeks, forehead, upper lip or nose. It is not harmful to your health, but it can be frustrating, especially when it affects confidence and keeps coming back after treatment. Many try creams or cosmetic procedures that work for a short time, but the spots return. This happens because melasma is often more than just a surface problem. In many cases, the root cause starts inside the body.
While sunlight and heat are known to make melasma worse, the main reason it develops in the first place is not completely understood. Experts agree that internal factors play a major role. Hormones, thyroid health and the liver are often mentioned as possible contributors. This means that even if you protect your skin from the outside, you also need to look inside for solutions.
What Is Melasma
Melasma is a form of hyperpigmentation, meaning certain areas of the skin look darker than the rest. This darker shade comes from excess melanin, the pigment that gives skin, hair and eyes their color. In this condition, pigment cells called melanocytes make more melanin than normal, which collects in the upper layers of the skin and creates uneven patches.
Although melasma is not dangerous and does not turn into skin cancer, it can last for years. It is more common in women than men, especially between the ages of twenty and forty. People with medium to dark skin tones are more likely to get it because they naturally have more active pigment cells. Pregnancy is a common trigger, which is why melasma during pregnancy is often called the “mask of pregnancy”. Birth control pills and hormone therapy can also play a role. Some people may notice their spots get a little darker at certain points in their menstrual cycle, but this is usually mild.
Sunlight is one of the strongest external triggers. Ultraviolet rays stimulate pigment production, which makes the spots darker and more visible. Heat, even without direct sunlight, can also activate pigment cells. This is why melasma is often worse in hot climates or during summer months.
What Causes Melasma
The exact cause of melasma is still unknown. However, research suggests that several internal and external factors are involved.
How Hormones Like Estrogen and Progesterone Trigger Melasma
Hormones are chemical messengers that control many processes in the body, including how much melanin the skin produces. Estrogen and progesterone, the main female reproductive hormones, can stimulate pigment cells to make more melanin. This is why melasma often appears or worsens during pregnancy, while using birth control pills, or during certain phases of the menstrual cycle.
When hormone levels shift, melanocytes (the cells that produce pigment) can become more active. In some people, this leads to uneven skin tone. It is not only reproductive hormones that matter. The stress hormone cortisol can also affect melanin production. High cortisol levels, especially over long periods, can create inflammation in the skin and make pigment cells more reactive.
If your melasma developed suddenly or worsened without a clear cause, it is worth checking your hormone balance. Doctors can test estrogen, progesterone, testosterone, cortisol and thyroid hormones to see if any imbalances could be contributing.
Can Thyroid Problems Cause Melasma?
The thyroid is a butterfly shaped gland at the base of your neck that controls metabolism, energy levels and many other body functions. It produces hormones such as T3 (triiodothyronine) and T4 (thyroxine), which influence how cells grow and repair.
Some studies suggest that thyroid disorders (both overactive and underactive) may be linked to melasma. The connection is not fully proven, but there are theories. One idea is that thyroid hormones can indirectly affect estrogen and progesterone levels. Another is that thyroid problems might increase skin sensitivity to sunlight, making pigmentation worse.
If you suspect thyroid issues, your doctor may order tests for TSH (thyroid stimulating hormone) and FT4 (free thyroxine). Symptoms like unexplained weight changes, fatigue, hair loss or temperature sensitivity can be clues that your thyroid might be involved.
How Liver Health Affects Hormones and Melasma
The liver is one of the hardest working organs in your body. It filters toxins, processes nutrients and helps break down hormones once they have done their job. If the liver is overloaded (from alcohol, processed foods, certain medications or chronic stress) it may not clear hormones as effectively.
When excess estrogen or other hormones remain in circulation, they can stimulate pigment production in the skin. This is why supporting liver health is an important step in melasma care. Eating cruciferous vegetables like broccoli, cauliflower, kale and arugula can help because they contain compounds that assist the liver in breaking down estrogen. Drinking enough water, limiting alcohol and avoiding heavily processed foods can also reduce the liver’s workload.
Some people use liver supporting supplements such as milk thistle or N-acetyl cysteine, but it is best to discuss these with a healthcare provider to ensure they are safe and suitable for you.
How Stress and High Cortisol Levels Make Melasma Worse
Stress is not just an emotional state. It triggers a chemical reaction in the body. When you feel stressed, your adrenal glands release cortisol, which prepares the body to deal with challenges. Short term stress is normal and even helpful, but chronic stress keeps cortisol levels high for long periods.
High cortisol can increase inflammation, disrupt hormone balance and even affect blood sugar levels. These changes can make pigment cells more active and harder to calm down. For people with melasma, stress often makes the patches darker or more resistant to treatment.
Managing stress is not about avoiding all challenges in life but about training your body to recover more quickly. Practices such as deep breathing, meditation, gentle yoga or even regular walks in nature can lower cortisol. Keeping a consistent sleep routine and taking breaks from screens can also make a difference.
How Sun Exposure Triggers Melasma
The sun is one of the biggest triggers for melasma. When ultraviolet (UV) rays reach the skin, they stimulate melanocytes to produce more pigment, deepening existing spots and sometimes creating new ones. Pigmentation can return quickly, even after addressing hormonal or liver imbalances, if sun exposure is excessive. You should apply broad-spectrum mineral sunscreen with SPF 50 that contains zinc oxide or titanium dioxide, which physically block UV rays. Wear a wide-brimmed hat, use safe sunglasses, and stay in the shade during the strongest sun hours, usually between 11AM and 4PM. This does not mean avoiding the sun completely because we need sunlight for vitamin D and overall health. You can safely get some sun by exposing your legs and arms when the sun is not too strong.
The Role of Heat in Melasma Flare Ups
Heat also plays a role. It can activate pigment cells even without direct sunlight. Hot climates or activities like cooking over a hot stove or spending time in saunas make melasma worse. Accessories can also matter. Sunglasses with metal frames, such as some Ray-Ban styles, heat up in the sun and transfer warmth to the skin around your eyes and cheeks, which can trigger pigmentation in sensitive areas. Choose sunglasses with plastic frames or frames that do not touch your skin in areas prone to melasma.
How Harsh Skincare and Treatments Can Trigger Melasma
Using strong scrubs or harsh skincare can make melasma worse because it irritates your skin. Even some chemical peels or laser treatments done the wrong way can darken spots. Gentle, soothing products are the safest choice to keep your skin calm.
How Diet and Lifestyle Choices Affect Melasma
Diet and lifestyle have a strong impact on skin health and hormone balance. Too much sugar, processed snacks and fried foods can raise inflammation in the body and place extra strain on the liver. Over time, this can make it harder for the body to keep hormones balanced and for the skin to stay even in tone.
Is Melasma Genetic? How Family History Plays a Role
Melasma can run in families, so if your parent or grandparent have it, you might be more prone to developing it too. How your skin reacts to sunlight and hormones is partly influenced by your genes. While you can’t change your genetics, knowing your risk can help you take better care of your skin early on.
Is Melasma Really Untreatable?
Many people hear from their doctor or dermatologist that melasma cannot be cured. This is true in the sense that melasma can always come back if the things that trigger it are still there. But that does not mean you have to live with dark spots forever. With the right care, you can make them much lighter and keep them under control so they are barely visible. The secret is to work both from the inside and outside at the same time.
Here are some of the most common treatments for melasma. These do not remove the main cause, but they can make the spots lighter and the skin look more even.
Topical creams
Prescription creams with ingredients like hydroquinone, tretinoin, azelaic acid or kojic acid can slowly fade dark spots. Sometimes these ingredients are used together for better results. You should understand that this is not a permanent cure. If you stop using these creams, melasma is likely to come back. Hydroquinone is not recommended for long term use because it can irritate the skin and in rare cases, cause a permanent darkening called ochronosis.
Chemical peel
Chemical peels use special acids such as glycolic acid, lactic acid or salicylic acid to gently remove the top layer of skin. This encourages new skin to grow, which can be more even in color. I tried the Cosmelan peel, which is often recommended for melasma. After about four months, my melasma slowly came back. It is not a cheap treatment, so it is important to be aware of that before trying it.
Laser treatments
Some gentle lasers, like Q-switched or pico lasers, can break up pigment without harming the rest of the skin. You need to be careful because too much heat can make melasma worse, so it is not suitable for everyone. I personally haven’t tried this treatment because I am concerned about rebound melasma, which can sometimes come back darker and even spread to new areas.
Tranexamic acid
This is a medicine that can be used as a cream or taken in pill form under a doctor’s guidance. It works by calming pigment cells so they make less melanin. Oral pills like tranexamic acid can be quite effective for some people, especially when melasma is stubborn and doesn’t respond well to creams or sun protection alone. But the effectiveness varies from person to person and melasma often comes back once the pills are stopped. So while they can be very helpful, they are not a permanent cure. Long term use is not recommended because of possible side effects, including effects on the liver, blood clotting or other health issues.
Polypodium leucotomos
Fernblock® (Polypodium leucotomos extract) does not directly remove melasma, but research shows it protects the skin from UV and visible light damage and reduces oxidative stress, which are major triggers for melasma. By lowering these triggers, it helps prevent melasma from getting worse and can make other treatments, like sunscreen and topical creams, work better. It does not cure melasma on its own, so you should always use it together with sun protection and other treatments. I personally take a Polypodium leucotomos supplement when I go on vacation during the summer.
Camouflage makeup
Makeup can completely cover melasma for the day. It is not a treatment, but it can help you feel more confident while working on other solutions. But instead of regular makeup, I usually use a tinted SPF 50 cream with high UVA protection or tinted SPF sun sticks, which protect my skin while giving some coverage.
Even the most effective treatments will give better results if you also protect your skin from the sun, stay away from too much heat and support your hormone and liver health.
Supporting natural hormone balance for melasma causes and treatments
Your daily habits affect your hormone levels just as much as your diet does. Getting seven to nine hours of sleep each night helps keep cortisol and reproductive hormones stable, which can reduce one of the triggers of melasma. Regular physical activity like walking, swimming, or cycling helps regulate estrogen and insulin levels, supporting overall skin health.
Managing stress is essential for melasma prevention and treatment. Meditation, deep breathing, yoga, journaling, or spending time in nature can lower stress and help your body recover.
Some supplements may help, but it is best to talk to a doctor first. Many people with pigmentation problems have low vitamin D. Zinc and vitamin C support skin repair and immune function. Myo inositol may help if you have insulin resistance, which is sometimes linked to hormonal imbalances like polycystic ovary syndrome.
Sun protection is a must for melasma
Even when internal factors are under control, the sun can quickly reactivate melasma. Sunscreen should be a daily habit. A mineral sunscreen with SPF 50 containing zinc oxide or titanium dioxide offers strong protection. It should be applied every morning and reapplied during the day when outdoors. Wearing a wide brimmed hat and staying in the shade during the hours when the sun is strongest, usually between 11AM and 4PM, will also help. Remember that even one sunburn can undo months of progress in fading melasma.
My personal journey with melasma
I have struggled with melasma for a while and learning what triggers it and how to treat it has been a long process. Over time, I tried different treatments, including hydroquinone creams and Cosmelan peels, but the dark spots came back each time. Using various sun protection methods taught me that consistency really matters.
Also I have to be careful with heat because it triggers my melasma. During summer vacations, even when I stay in the shade most of the time, warm weather for about a week makes my melasma flare up. Exercise can also trigger melasma, but I stay less cautious about it because the benefits for my overall health and stress reduction outweigh the small risk of flare ups.
Over the years, I made progress with my melasma. Today, it looks much better, is barely visible and I can easily cover it with makeup. I found that protecting my skin from the sun, following healthy lifestyle habits and reducing stress in my life make the biggest difference.
Conclusion – melasma causes and treatments
The best way to deal with melasma causes and treatments is to take care of your body inside and outside. Check for hormone imbalances with medical tests and make healthy lifestyle changes. Eat fresh, nutrient-rich foods to support your liver and reduce inflammation. Manage stress and eat antioxidants and always protect your skin from the sun and heat.
By treating melasma at its roots and maintaining good skin habits, you are not only fading existing patches but also reducing the chances that they will return. This approach takes time and patience, but it gives the best chance for lasting results and healthier skin overall.
