Causes and Treatment of Melasma and Uneven Skin Color

Jun 25, 2022 | Conditions, Dr. Lana Wicentovich

Close up photo of a microneedling treatment done on the forehead of a patient

Causes & Treatment for Uneven Skin Colour

When it comes to skin, many people look towards maintaining an even and glowing complexion. Unfortunately, melasma is a common condition that can cause brown patches across the face and other sun exposed areas.

For some people, this can effect their emotional well-being and impact their social interaction. 

What is melasma?

Melasma is a chronic condition.  It is a pigmentation disorder causing symmetrical blotchy brown or brown-grey patches on the skin. These patches are most commonly found on the face, particularly the cheeks, bridge of the nose, forehead, upper lip and chin, but other areas that are exposed to sun can also be affected (arms and neck).

Some melasma effects pigmentation in the epidermis (the outermost layer of the skin), while other times it effects the dermis deeper down. Some people have a mixed type, affecting both the dermal and epidermal layers. When the deeper dermis is affected, it is more difficult to treat.


Eight triggers and risk factors to developing melasma:

  1. Women of reproductive age are more commonly affected than men.  Though, 10% of patients seeking treatment for melasma are men.   If you have relatives with melasma, there is an increased chance that you may develop it. People with darker skin tones are more affected by melasma.
  2. Sun exposure and damage to the skin by sun is the biggest trigger for melasma. The good news is that this is also the most avoidable risk factor.
  3. Pregnancy can trigger melasma.  In this context, it is known as cholasma (the mask of pregnancy).  This is because estrogen and progesterone (hormones involved with reproduction) influence pigment-producing cells in the body. In this situation, the pigmentation often fades a few months after delivery.
  4. Just like in pregnancy, hormones taken by a patient can induce melasma.  Medications that commonly contain estrogen and progesterone include the oral contraceptive pill, hormone replacement therapy, and interuterine devices.
  5. Certain non-hormone based medications may trigger melasma.  These include some new cancer therapies and anti-epileptic medications.
  6. Cosmetics can trigger melasma, so people need to be careful.  Certain soaps, deodorant soaps and cosmetics can cause a phototoxic reaction that triggers melasma.
  7. Thyroid disorders may trigger melasma.
  8. For some individuals facial waxing can cause skin inflammation, which can trigger melasma. 

Two treatments for melasma: 

Prevent Pigment Gain

The most important thing that can be done to prevent and help melasma is sun protection.  Wear sunscreen everyday containing at least SPF 30.  Reapply every 2 hours when out in the sun.  It’s a good idea to wear make up that contains sunscreen.

Mineral makeup is a great option.  It provides excellent camouflage to existing melasma, and because it contains titanium dioxide and zinc oxide, it provides additional sun protection. 

Promote Pigment Loss

1. Topical Therapies

Preparations that inhibit melanin productions (the cells that produce skin pigment) or skin lightening agents.  Some of these products can be found at the drug store, but physicians can prescribe these in higher more effective concentrations if the over-the-counter preparations are not providing benefit.  It is important to be monitored by a physician as some of these products can cause an irritation to the skin.

In patients with sensitive skin, this could cause new post-inflammatory pigmentation problems.

  • hydroquinone
  • azelic acid (safe for use in pregnancy)
  • Kojic acid
  • Vitamin C
2. Other topical therapies
  • Topical corticosteroids
  • Soybean extracts
3. Agents that induce peeling of the epidermis.

These agents are more effective when the melasma is more superficial in the epidermis. Treatments include:

  • Topical retinoids such as tretinoin (do not use in pregnancy)
  • Topical alpha hydroxyl acid

The most successful topical method is using these therapies in combinations under the guidance of a physician.  Many people will experience improvement using a cream that combines hydroquinone, tretinoin and moderate potency topical steroids.

4. Physical Methods
  • Chemical Peels
  • Microdermabrasion
  • Laser and light therapies under the care of a skin specialist

In summary, there are many options to treat uneven skin tone.

Please consult a skin professional whom you trust.

Book your appointment 

At Stratica, we emphasize a rejuvenated and confident you. We want to find a personalized approach to your skin goals and emphasize your desired results. Book your free consultation today to discuss with one of our expert providers to learn how filler treatments fit into your aesthetic goals. 

How should I prepare for my treatment?

Before your appointment, it is advised to adhere to the following pre-treatment guidelines: 

  • Avoid sun exposure 2 weeks prior to your treatment
  • Avoid the use of active ingredients one week prior (such as retinoids, glycolic acid, lactic acid, salicylic acid, or kojic acid) 
  • Avoid abrasive scrubs or exfoliants for 2 weeks prior
  • Avoid cosmetic injections such as Botox, Dysport, or Filler 2 weeks prior 

To maximize results, we recommend discontinuing the following substances at least 3 days before your treatment: 

  • Isotretinoin / Accutane or Epuris
  • Aspirin / ASA
  • Ibuprofen / Advil
  • Naproxen / Aleve
  • Antibiotics
  • Ginkgo Biloba
  • Vitamin-E
  • Alcohol
  • St. John’s Wort
  • Green Tea extract
  • Omega 3- Fatty acids
Is there any downtime or aftercare?

Post-treatment, the area may feel like a sunburn with slight redness, tightness, dryness, and sensitivity to touch, which is considered normal healing. 

Peeling may occur 3-7 days after treatment, it is advised to not rub, scratch, or pick at the treated area. 

A follow-up appointment with your service provider is essential two weeks after your initial session.

After the appointment, refrain from touching, rubbing, or manipulating the injection areas unless instructed by your physician or nurse injector. Avoid exposure to extreme heat (sun, saunas, hot yoga, tanning beds) and strenuous activities for 2-3 days post-appointment. Refrain from applying makeup for at least 24 hours. Showers are permitted, but gently cleanse the area then pat dry. Do not rub with a towel or washcloth as the area is extremely delicate.


Pin It on Pinterest