Dark spots it is the bane of my existence. Despite working as a beauty editor for the past decade, with access to every fancy new product that promises to even out skin tone, I still woke up in my early 30s with skin riddled with melasma. I’m also not the only one. ONE 2017 study found that up to 50 percent of people in certain geographic locations (melasma is more prevalent with exposure to sunlight) experience this troublesome form of hyperpigmentation, which is also notoriously difficult to treat.
“Melasma causes spots, discolored patches of skin to appear,” explains Chaneve Jeanniton, MD, board-certified ophthalmic facial plastic surgeon and founder of epi.logic skincare. “It usually appears on the face and is symmetrical, affecting the cheeks, forehead and upper lip.” He adds that although melasma will look different on someone with a lighter skin tone than someone with more melanin, the degree of darkening will remain relative to the person’s base skin tone. For myself, with my Western European heritage, this means that my otherwise pale skin develops tonsil spots in these three areas of the face every summer and falls like clockwork. Funny things!
Unfortunately, genetics is only half the battle when dealing with melasma. Dr. Jeanniton says that hormones, especially estrogen and progesterone, and lifestyle factors, such as UV exposure, can also trigger the development of melasma. “Although still debated, stress appears to cause melasma due to increased cortisol,” she adds. Like every 34-year-old woman on planet Earth, stress is just an inevitable fact of life, so the idea of minimizing it along with all the other potential melasma culprits can feel especially overwhelming.
“Melasma is difficult to treat for a number of reasons,” says Macrene Alexiades, MD, PhD, FAAD, a board-certified dermatologist and founder of Macrene Actives. He cites the depth of pigmentation, the chronic nature of the condition, hormonal fluctuations and variable response to treatment as the main complications in treating melasma. But even this list of obstacles couldn’t stop me from trying to achieve even-toned and previously glowing skin. If the celebrity set can do it (at least according to all those popular “no makeup” mornings we see on TikTok), then so can I. This time, however, I turned to the professionals for help.
Start with topical products for melasma
Mild cases of melasma, also known as those that are still in the early stages and are quite superficial, can achieve significant relief with the use of topical products. Both Dr. Jeanniton and Dr. Alexiadis suggests patients try products with specific active ingredients before turning to more invasive options. “The gold standard topical treatment for melasma is a prescription cream consisting of a triple combination of tretinoin, hydroquinone, and a corticosteroid,” says Dr. Jeanniton. However, hydroquinone (a skin lightening agent) may worsen hyperpigmentation in patients with deeper skin tones.
If you’d rather not get a subscription, or if hydroquinone is too risky to use on your skin tone, she suggests trying products that contain targeted pigment-reducing agents like retinoids — like epi.logic Double feature — tranexamic acid — as Top fade serum — niacinamide — as Maelove NIA 10 serum — and alpha-hydroxy acids, such as U Beauty Resurfacing Compound. Of course, you’ll want to make sure you don’t use these types of products in quick succession, as this is a surefire way to cause skin inflammation. Start with one or two alternate days a few times a week to avoid irritation, then work your way up from there to see more significant results.
See a professional for a chemical peel
Once melasma reaches a deeper component in the skin, beyond the epidermis to the dermis, it is categorized as moderate to severe and therefore more difficult to treat. And if, like me, you’ve struggled with chronic, recurring melasma for many years, professional intervention is probably the best course of action.
It’s tempting to try one of the many at-home chemical peel products on the market right now, but they may not be the right route for treating your melasma. “I would advise staying away from chemical peels at home if you’re dealing with melasma,” says Dr. Jeanniton. “They can cause melasma and make hyperpigmentation worse and harder to treat.” Instead, make an appointment with your favorite facialist to try a professional glycolic (or other alpha-hydroxy acid) peel. A board-certified plastic surgeon or dermatologist will also offer professional peels that suit your skin without aggravating pre-existing dark spots.
I’ve tried peels in the past with varying levels of success, but after a summer of (too much) sun exposure, I decided to visit Dr. Alexiadis to her Manhattan practice to explore an alternative treatment.
Try a laser treatment for melasma, but be careful
Skin care lasers are very popular, but just because your provider has a fancy machine in her office doesn’t mean it’s the best option for treating melasma. As explained by Dr. Alexiadis, “Some laser treatments can actually make melasma worse,” as these types of energy devices generate heat, which in turn triggers inflammation and the production of melanocytes (the cells that give your skin its color). He suggests looking for providers that have either a Q-Switched or Picosecond Nd:YAG laser. For my treatment, we went with the latter.
“Picogenesis at 1064 nanometers allows this laser wavelength to be delivered in a picosecond pulse duration,” says Dr. Alexiadis. “It breaks down the pigment in a sub-cellular, gentle way without overheating or killing the cells. This results in a gradual reduction of the abnormal pigment in melasma, leaving your normal skin alone.”
To achieve the maximum possible illumination, Dr. Alexiadis delivers three Pico laser treatments four weeks apart starting in October, which she describes to her celebrity clients as the start of the “Pico era.” She explains, “My mandatory rule is to stay out of the sun for four weeks before and four weeks after each treatment. This allows the tan to fade sufficiently so that the laser can target the abnormal pigment and leave your underlying pigment alone. October gives me the chance to do three monthly treatments before December when people go on holiday again.’
Fortunately, the treatment itself isn’t painful—rather, it feels like the briefest tap of a rubber band on your skin. I just stumbled upon the very stylish goggles, I could hold a conversation without grimacing for the entire five minutes it took Dr. Alexiadis to slather my cheeks, upper lip, and forehead. It’s also a safe option for all skin tones, which isn’t usually the case with lasers. “I’ve safely treated very deeply pigmented skin and just adjusted my flow and number of hits,” says Dr. Alexiadis. Be sure to see a provider experienced in treating your skin tone to ensure you get the best possible results.
Maintain your results and keep melasma at bay
Afterwards, my skin was slightly red, but nothing compared to getting radio frequency microneedling. When I got back to my apartment, you would never know that I had received a powerful laser treatment. Additional aftercare is also small but extremely important. Sun protection is non-negotiable and Dr. Alexiadis urged me to look for an SPF 100 option, like the La Roche-Posay Anthelios Melt-In Milk Sunscreen for Face & Body SPF 100.
By the end of my third session, I could barely tell how even my skin looked. The relentless darkness along my cheekbones finally matched my jaw, and the dark spots on my forehead were nowhere to be found. My skin really did feel, as Dr. Alexiadis promised, like butter.
I’d love to say that once I, or anyone else struggling with melasma, walks out the door after a professional treatment, the pigmentation doesn’t come back, but few things in skin care are that simple. Unfortunately, as Dr. Jeanniton explains, “Even if we’re able to clear the hyperpigmentation, there’s still a chance it will come back. That’s why if you’re prone to melasma, it’s especially important to take a preventative and defensive approach, especially during the summer months, to keep the condition under control.”
This means diligent use of sun protection (SPF and protective clothing) and application of care products with active ingredients to exfoliate and brighten the skin. And if the blackheads return, as mine surely will, make an annual appointment with your favorite skin care provider for your choice of laser or chemical peels. Yes, it’s not always the cheapest option (Pico lasers at Dr. Alexiadis’ office will run you about $1,000 per session), but if few other treatments have worked for your skin, I can attest that the results are definitely worth the budget .
The best products for melasma-free skin
epi.logic Dual Action Retinol + AHA Overnight Face Treatment
Topicals Faded Serum for dark spots & discoloration
Maelove NIA 10 Serum Niacinamide
U Beauty The Resurfacing Compound Skin Care Treatment
La Roche-Posay Anthelios Melt-in Milk Body & Face Lotion Broad Spectrum SPF 100
EltaMD EltaMD UV Shield Broad Spectrum SPF 45
Hannah Baxter is a beauty and wellness writer, consultant, and former associate beauty editor at The Zoe Report, where she oversaw the site’s beauty division. Previously, she was senior beauty editor at Coveteur and is now a regular contributor to outlets such as Allurebirdie, Harper’s Bazaar, Glamor, hustle and bustle and more. She is also the founder of Anxiety Beer, a bi-monthly newsletter that destigmatizes conversations around mental health.
