Melasma treatment: what helps, and who treats it
Melasma is a skin condition that causes tan, brown or gray-brown patches, usually on the cheeks, forehead, chin or upper lip. A board-certified dermatologist should diagnose and treat it, often with daily sun protection plus prescription creams. A facial cannot treat melasma. Karisma's $125 Signature Facial can be a gentle facial alongside your dermatologist's plan.
Published · Written by Kay Woodson · Results vary.
What is melasma, and who gets it?
Melasma shows up as patches and freckle-like spots in tan, brown, grayish brown or bluish gray. It tends to sit in symmetrical places on the face, such as both cheeks, the forehead or the skin above the upper lip. Darkening that circles the mouth can have other causes, covered in hyperpigmentation around the mouth.
According to the AAD, it is much more common in women than in men, more common in medium and dark skin tones, and most likely between the ages of 20 and 40. Having a blood relative with melasma raises the odds too.
What triggers melasma?
The AAD lists these triggers. Many women have more than one.
- Sunlight. UV exposure prompts the skin to make more pigment.
- Visible light. The AAD notes it has been shown to worsen melasma, especially in darker skin tones.
- Pregnancy. Rising estrogen and progesterone are thought to set it off.
- Birth control pills, some anti-seizure medicines and drugs that make skin more sensitive to the sun.
- Tanning beds and thyroid disease. Stress is also listed, though the AAD calls that link controversial.
Source: AAD, "Melasma: Who gets and causes" and "Melasma: Self-care".
Melasma treatments compared
The AAD says the most effective approach often pairs sun protection with medicine, and sometimes a procedure. Rows marked "not offered" are not available at Karisma.
| Option | What it is | Who provides it |
|---|---|---|
| Sun protection | Tinted sunscreen with iron oxide and SPF 30 or higher, shade, a hat with a UPF label | You, every day |
| Hydroquinone | Evens out tone. No longer sold without a prescription | A dermatologist |
| Tretinoin plus a mild corticosteroid, or a triple cream | A retinoid with an anti-inflammatory, sometimes combined with hydroquinone | A dermatologist |
| Azelaic acid, kojic acid, vitamin C | Gentler options the AAD lists | A dermatologist, or you with their advice |
| Tranexamic acid | A pill or a cream, kept for melasma that resists other treatment. Tell your doctor if you have had a blood clot | A dermatologist |
| Chemical peel, microneedling, laser or light, PRP | The AAD says only a board-certified dermatologist should perform these for melasma | A dermatologist. Not offered at Karisma |
| Gentle facial | Cleansing, hydration and calm. It does not treat melasma | Karisma, Signature Facial, $125 |
AAD, "Melasma: Diagnosis and treatment", last updated February 15, 2022.
Why does melasma keep coming back?
Because its triggers keep coming back. Melasma can fade by itself, often after a pregnancy ends or once a medicine that set it off is stopped. It can also last for years. The AAD says sun protection can help it fade and help stop it from returning.
On the Space Coast, that means protection on cloudy days, in the car and on the school run, not only at the beach. It also explains why a single treatment rarely settles the matter. Melasma is managed over time, with a dermatologist steering.
See a dermatologist first if
The patches are new and nobody has told you what they are. You are pregnant or breastfeeding. You want a peel, laser or any procedure. A dermatologist can tell melasma apart from other causes of discoloration.
A facial can fit when
You already have a diagnosis and a plan, and you want a calm facial that does not fight it. Bring the names of your prescription products so nothing in the facial works against them.
What Karisma offers, and what it does not
Kay does not diagnose or prescribe, and Karisma does not sell a melasma treatment. What the studio can offer is the Signature Facial, $125 for about 60 minutes with the consultation included. Tell Kay you have melasma so she can keep the visit gentle. The AAD warns that products that burn or sting can darken dark spots.
The Advanced Facial, at $225, adds a superficial peel and exfoliation. Because the AAD keeps procedures for melasma with board-certified dermatologists, book it only if your dermatologist agrees. The same goes for red light therapy: it is visible light, so ask your dermatologist first.
Questions about melasma
What treatment works for melasma?
The AAD says the most effective approach often combines daily sun protection with prescription medicine, sometimes adding a procedure done by a dermatologist. Hydroquinone, tretinoin with a mild corticosteroid, and triple creams are common starting points.
Can a facial help melasma?
A facial cannot treat melasma. A gentle one can be part of a skin routine your dermatologist is happy with. Peels and resurfacing should wait for your dermatologist's go-ahead.
Does melasma go away after pregnancy?
It can fade on its own after pregnancy, according to the AAD. It can also stay for years. Daily sun protection helps it fade and helps prevent it from returning.
Is melasma the same as hyperpigmentation?
Melasma is one type of hyperpigmentation, tied to hormones and light. Other dark spots, from sun or old breakouts, behave differently. See hyperpigmentation and dark spots, or the side-by-side guide melasma vs hyperpigmentation.
Does insurance cover melasma treatment?
Usually not. The AAD notes that most insurers do not consider it medically necessary.
- Melasma: Overview, American Academy of Dermatology, last updated February 15, 2022, checked October 29, 2026
- Melasma: Who gets and causes, American Academy of Dermatology, last updated February 15, 2022, checked October 29, 2026
- Melasma: Diagnosis and treatment, American Academy of Dermatology, last updated February 15, 2022, checked October 29, 2026
- Melasma: Self-care, American Academy of Dermatology, last updated September 12, 2023, checked October 29, 2026
- Karisma Esthetics booking page and prices, GlossGenius, checked October 29, 2026