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Melasma Treatment
What Causes Melasma and Hyperpigmentation?
Melasma is driven by melanocytes—the pigment-producing cells in your skin—becoming overactive in response to hormonal shifts (pregnancy, birth control pills, hormone therapy) and sun exposure. UV light is the main trigger and amplifier, which is why melasma often worsens in summer and recurs without diligent sun protection. Genetics play a role too; it's more common in those with darker skin types and family history. Hyperpigmentation more broadly can also follow skin injury or inflammation, such as acne, cuts, or aggressive treatments, a pattern called post-inflammatory hyperpigmentation.
Treatment starts with strict sun protection and topical agents like hydroquinone, retinoids, or azelaic acid to calm melanocyte activity. Chemical peels can help selectively. Lasers and IPL are used cautiously, since heat-based devices can actually stimulate melanocytes and worsen melasma, particularly in darker skin. Any energy-based treatment should be approached carefully and individualized. A board-certified dermatologist or plastic surgeon can determine what's driving your pigmentation and build a safe, sequenced plan.
Clinical Context
Melanocytes sit at the base of the epidermis, in the basal layer along the dermal-epidermal junction, and hand off pigment granules called melanosomes to surrounding skin cells. In melasma, this handoff goes into overdrive, but where the extra pigment lands matters: epidermal melasma stays shallow and responds better to topical fading agents, while dermal or mixed melasma sits deeper, is harder to reach topically, and explains why some cases seem stubborn no matter how consistent the skincare routine is.
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