Can't Fade Melasma? Why Your Face Is Darkening & Medical Next Steps

If you've been trying to treat melasma and your dark patches won't fade — or seem to be getting worse — you're not alone. Melasma can be stubborn, slow to improve, and emotionally frustrating. While it's not dangerous, persistent skin darkening deserves proper attention.

Let's break down why melasma happens, why it sometimes worsens, and what medical steps actually work.

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What Is Melasma?

Melasma is a common skin condition that causes brown, gray-brown, or tan patches on the face. It most often appears on:

• Cheeks
• Forehead
• Upper lip
• Nose
• Chin

It can also appear on the neck or forearms in some people.

Melasma happens when melanocytes (pigment-producing cells) become overactive and produce too much melanin. The result: visible dark patches that don't fade easily.

Melasma is sometimes called chloasma, especially when it occurs during pregnancy.

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Why Is Your Face Getting Darker?

If your melasma isn't fading — or seems worse — there's usually a reason. The most common triggers include:

1. Sun Exposure (The #1 Cause)

Even small amounts of sunlight can reactivate melasma.

• UV rays stimulate melanin production.
• Visible light (including indoor light and screens) can worsen it.
• Heat alone can trigger pigment production.

This is why melasma often comes back in summer — even if you're using treatment creams.

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2. Hormones

Melasma is strongly linked to hormonal changes.

Common triggers:

• Pregnancy
• Birth control pills
• Hormone replacement therapy
• Thyroid disorders

If hormones are still fluctuating, pigment production may continue.

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3. Inflammation or Skin Irritation

Over-treating your skin can backfire.

Harsh scrubs, strong peels, or incorrect laser treatments can:

• Irritate the skin
• Trigger inflammation
• Cause more pigment production

This is called post-inflammatory hyperpigmentation, and it can overlap with melasma.

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4. Heat and Climate

Hot yoga, saunas, or warm weather can worsen melasma — even without sun exposure. Heat stimulates melanocytes directly.

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5. Genetics

Some people are simply more prone to melasma. It is more common in:

• Women
• People with medium to darker skin tones
• Those with a family history

If it runs in your family, it may be more persistent.

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Why Isn't Your Melasma Fading?

Many people try over-the-counter creams and see little improvement. Here's why that happens:

• The pigment may be deep in the skin (dermal melasma).
• Sunscreen use may not be strict enough.
• Treatment isn't strong enough.
• The trigger (like hormones) hasn't been addressed.

Melasma often requires a long-term strategy, not a quick fix.

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How Is Melasma Diagnosed?

Most doctors diagnose melasma by looking at your skin. In some cases, a dermatologist may use:

• A Wood's lamp (special light to assess pigment depth)
• A skin exam to rule out other conditions

If you're unsure whether your dark patches are melasma or something else, you can start by using a free AI-powered Chloasma symptom checker to help identify your symptoms and get guidance before your appointment.

However, online tools are not a replacement for medical care.

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Medical Treatments That Actually Work

Melasma treatment works best when it combines pigment control + sun protection + trigger management.

1. Prescription Topical Medications

These are often first-line treatments:

• Hydroquinone – Lightens dark patches by reducing melanin production.
• Tretinoin (Retinoids) – Speeds skin turnover.
• Topical corticosteroids – Reduce inflammation.
• Triple combination creams – Often combine all three above.

These are typically used for limited periods under medical supervision.

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2. Non-Hydroquinone Options

For those who cannot use hydroquinone:

• Azelaic acid
• Kojic acid
• Tranexamic acid (topical or oral in some cases)
• Niacinamide

Tranexamic acid has shown promising results for stubborn melasma, but oral use must be discussed carefully with a doctor due to potential clotting risks.

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3. Chemical Peels

Superficial peels (like glycolic acid or salicylic acid) may help some patients.

However:

• Aggressive peels can worsen melasma.
• They must be done carefully, especially for darker skin tones.

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4. Laser and Light Treatments

Lasers can help — but they can also make melasma worse if not done properly.

Safer options may include:

• Low-fluence Q-switched lasers
• Fractional lasers
• Intense pulsed light (IPL), with caution

These should only be done by experienced dermatologists familiar with melasma management.

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The Most Important Step: Sunscreen (Daily, No Exceptions)

No treatment works without strict sun protection.

Use:

• Broad-spectrum SPF 30 or higher (SPF 50 preferred)
• Tinted sunscreen (helps block visible light)
• Reapply every 2 hours outdoors
• Hats and shade when possible

Without this, melasma will likely return — even after successful treatment.

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When to See a Doctor

Melasma is not dangerous, but you should speak to a doctor if:

• Dark patches appear suddenly or change quickly
• You notice irregular borders or unusual colors
• You have symptoms like fatigue, weight changes, or menstrual changes (possible hormone issues)
• Over-the-counter treatments aren't working

In rare cases, facial pigmentation may be confused with other conditions that require medical evaluation.

If anything feels unusual, worsening, or concerning, speak to a doctor promptly — especially if there are signs of systemic illness.

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Can Melasma Be Cured?

Here's the honest answer:

Melasma can be controlled, but it often cannot be permanently cured.

Think of it like a chronic condition that requires maintenance. Many people experience:

• Improvement with treatment
• Recurrence with sun exposure
• Flares during hormonal changes

The goal is long-term management, not a one-time fix.

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Practical Daily Plan for Managing Melasma

A simple routine might look like:

Morning

• Gentle cleanser
• Antioxidant serum (like vitamin C)
• Prescription or lightening treatment
• Tinted SPF 50 sunscreen

Evening

• Gentle cleanser
• Retinoid or prescribed cream
• Moisturizer

Consistency matters more than intensity.

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Emotional Impact Matters Too

Melasma affects appearance — and that can affect confidence.

If you feel frustrated, discouraged, or self-conscious, that's understandable. Many patients report emotional stress related to visible skin changes.

Effective treatment and realistic expectations can make a big difference.

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The Bottom Line

If you can't fade your melasma, it's likely because:

• Sun exposure is still triggering pigment
• Hormones are playing a role
• The treatment plan isn't strong enough
• The pigment sits deep in the skin

Melasma requires patience, medical guidance, and strict sun protection.

If you're experiencing persistent dark patches and want to better understand what you're dealing with, try using a Chloasma symptom checker to evaluate your symptoms — then follow up with a healthcare professional for a proper diagnosis and treatment plan.

Most importantly, speak to a doctor about persistent, worsening, or unusual pigmentation — especially if anything feels serious or out of the ordinary. While melasma itself isn't life-threatening, proper evaluation ensures nothing more serious is being missed.

With the right plan, melasma can improve — even if it takes time.