Melasma: 5 myths and truths

Summary in 60 seconds

• Melasma is a common form of acquired hyperpigmentation that usually appears as brown or grayish spots, especially on the face.
• It is not an infection, it is not contagious, and it is not considered a precancerous lesion.
• Even so, it can significantly affect self-esteem and quality of life.
• Its most recognized triggers include ultraviolet radiation, visible light, genetic predisposition, and hormonal factors.
• One of the most common myths is thinking that «with a strong cream» it will be eliminated forever.
• Current evidence considers it a chronic condition, with a tendency to relapse, that requires sustained control.
• Sunscreen is important, but in melasma, more complete photoprotection is usually preferable, ideally with color and iron oxides.
• Procedures such as lasers, peels, or microneedling can help in some cases, but they can also irritate or worsen pigmentation if they are indicated incorrectly.
• The realistic goal is not to «erase» the skin, but to clarify, stabilize, and reduce relapses.
• Dermatological assessment helps to confirm the diagnosis and design a safe plan.

What is melasma and why does it appear?

Melasma is an acquired hyperpigmentation: the skin produces and distributes more melanin in certain areas, resulting in flat patches of light brown, dark brown, or grayish color. It commonly affects areas exposed to sunlight, especially the cheeks, forehead, upper lip, nose, and chin.

It is not a malignant lesion, it is not contagious, and it does not usually cause pain, itching, or scaling. The main impact is usually aesthetic and emotional, especially due to its facial location. In most cases, the diagnosis is made through clinical evaluation; in doubtful situations, tools such as dermatoscopy, Wood’s lamp examination, or, rarely, biopsy may be used. American Academy of Dermatology 2022

Melasma does not usually have a single cause. It is more accurately understood as a multifactorial condition, where several elements increase the skin’s pigmentary activity.

Among the best-recognized factors are ultraviolet radiation, visible light, family history, pregnancy, contraceptives, other hormonal treatments, some medications, and skin inflammation. The Latin American consensus describes it as a chronic and recurrent disorder, more frequent in adults, women, and those with darker skin tones, with significant involvement of sun exposure, hormones, and genetic predisposition. Ocampo-Candiani 2025

Aggressive exfoliations, homemade mixtures, irritating cosmetics, or poorly indicated treatments can cause inflammation and promote more pigmentation.

5 myths and realities

Myth 1: “Melasma goes away forever”

Reality: It can improve significantly, but it tends to behave like a chronic and recurring condition. Talking about a «definitive cure» often creates unrealistic expectations.

Current evidence and consensus recommend focusing on long-term management: reducing triggers, lightening pigmentation, and maintaining consistent sun protection. Preventing relapses is as important as initial lightening (StatPearls 2026) .

Myth 2: “It only appears because of the sun”

Fact: Sun exposure is a major factor, but not the only one. Melasma can also be related to pregnancy, contraceptives, hormone therapy, family history, some medications, and individual skin sensitivity.

Ultraviolet radiation and visible light can influence pigmentation, but in many people melasma appears due to a combination of factors. Therefore, treating it simply as «sunspots» can oversimplify the problem. British Association of Dermatologists 2024

Myth 3: “Any sunscreen will do”

Fact: In melasma, the choice of sunscreen matters. A broad-spectrum sunscreen is essential, but many people benefit from tinted formulas containing iron oxides, because they help protect against some visible light.

Sun protection for melasma should cover UVB, UVA (including UVA1), and visible light radiation. Tinted sunscreens play a significant role because their pigments can enhance protection against visible light. Morgado-Carrasco 2022

Myth 4: “If a cream burns, it’s working”

Fact: Burning, irritation, or intense peeling are not signs of effectiveness; they may be signs of barrier damage or irritant dermatitis. In skin prone to pigmentation, inflammation can worsen dark spots.

Treatments such as hydroquinone, retinoids, acids, depigmenting combinations, or compounded formulas can be helpful, but they require specific indications, duration, and follow-up. Higher concentrations or more products do not necessarily mean better results.

Myth 5: “Laser treatment is the fastest solution”

Reality: Some devices can be helpful in selected cases, but they aren’t the first-line solution for everyone. In melasma, procedures can lighten, not lighten enough, or even worsen pigmentation if they cause inflammation.

Lasers, pulsed light, peels, and microneedling should be considered with caution, ideally when the skin is stable, with a clear diagnosis, and under strict sun protection. These procedures do not replace the underlying treatment or maintenance.

In conclusion

Melasma is a common, chronic, and multifactorial condition that should be addressed with clear information and realistic expectations. Common myths—such as the belief that it’s permanently curable, that it’s solely caused by sun exposure, that any sunscreen is sufficient, that irritation indicates effectiveness, or that laser treatment is a quick fix—can lead to impulsive decisions and unsafe treatments. The reality is that managing melasma requires consistency, adequate sun protection, maintaining a healthy skin barrier, and, when appropriate, treatments prescribed by a dermatologist. Rather than seeking immediate elimination, the reasonable goal is to lighten the spots, stabilize the skin, and reduce the risk of recurrence.