Even though pregnancy is the condition most commonly associated with melasma, melasma has also been known to occur with medications and conditions that impact your hormones. Oral contraceptives and hormone replacement therapy are the next two most common causes of melasma, after pregnancy. You can stop use or try switching to a different product to determine if your melasma will fade naturally afterward.

Begin taking hormone replacements at night. If you take the hormone replacement in the morning, it will be at its peak potency when the sun is out, maximizing the risk of melasma. Shifting your regimen to the night can help alleviate the problem. Creams and patches might be slightly less inclined to cause melasma than oral versions of the treatment. Ask your doctor to administer the lowest dose feasible. [2] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source

Hydroquinone comes as a cream, lotion, gel, or liquid. It works by blocking the natural chemical process in your skin responsible for creating melanin, and since melanin produces dark skin pigmentation, the amount of dark pigmentation related to melasma will also be reduced. Prescription hydroquinone typically has a concentration of 4 percent. Concentrations of hydroquinone higher than 4 percent are unlikely to be prescribed in the United States and can be dangerous. They can cause ochronosis, a permanent form of skin discoloration. [3] X Research source

Tretinoins and corticosteroids are among the most frequently used secondary treatments. Both are used to speed up the body’s process of shedding and replacing skin cells. Some dermatologists may even prescribe “triple creams,” which contain tretinoin, a corticosteroid, and hydroquinone in one formula. Other options include azelaic acid or kojic acid, which slow down the production of skin-darkening pigment.

The liquid chemical is applied to the skin, creating a mild chemical burn. As the burned layers peel off, they leave behind fresh, melasma-free skin. This will not, however, prevent melasma if you have not treated underlying hormonal imbalances. While glycolic acid is one of the most common options used, another common option is trichloroacetic acid, which is a compound similar to vinegar. Peels done with this chemical can be slightly more painful afterward, however, but they may present a good option for severe cases of melasma.

Both dermabrasion and microdermabrasion are medical procedures that essentially “sand off” the surface layer of skin using abrasive materials. During microdermabrasion, fine crystals are vacuumed across the skin. These crystals are abrasive enough to forcibly strip away dead skin cells, thereby lifting away the affected skin. You can usually get about five procedures done, each two to four weeks apart. You may also opt for a maintenance treatment that every four to eight weeks if the underlying cause of your melasma has not been treated.

Fractional laser treatments tend to be expensive and may cost $1000 or more. Keep in mind that you will probably need three to four treatments over the course of three to six months. [7] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source

Apply sunscreen 20 minutes before you anticipate being out in the sun. Look for a sunscreen with an SPF of 30 or higher, and consider getting one with added nutrients, like zinc, to benefit your skin. You could try “double” sun screening, as well. Layer an SPF 15 sunscreen on beneath an SPF 30 sunscreen for even more protection. Wear a wide-brimmed hat and large sunglasses to provide your face with additional protection. If your melasma is especially bad, you might also want to consider wearing long-sleeved shirts and pants. Try to stay out of direct sunlight as much as possible.

If you have difficulty relaxing, try techniques like meditation or yoga. If these do not work for you or do not appeal to you, simply make time for more things you enjoy—whether that includes walks through the park, reading, or taking a bubble bath.

Hydroquinone comes as a cream, lotion, gel, or liquid. It works by blocking the natural chemical process in your skin responsible for creating melanin, and since melanin produces dark skin pigmentation, the amount of dark pigmentation related to melasma will also be reduced. There are even hydroquinone creams that contain a little sunblock, so if you want to protect your skin while treating it for melasma, these options provide an all-in-one opportunity for you to do so. Nonprescription hydroquinone creams usually have a concentration of 2 percent or less.

Cysteamine, is the natural product of L-cysteine metabolism in the human body. It acts as an intrinsic antioxidant and is known for its protective role against ionizing radiation and as an antimutagenic agent. Cysteamine acts via the inhibition of melanin synthesis to produce depigmentation.

Note, however, that this alone may not cure your melasma if the underlying cause has not also been remedied. The affected skin will shed quicker, but that will have no impact if your new skill cells are all affected.

Cases of melasma not caused by pregnancy can last longer and might require more active intervention to treat. [15] X Research source