Melasma & Dark Spots

Melasma and other forms of hyperpigmentation occur when melanocytes produce excess pigment. Common triggers include sun and visible light exposure, hormonal influences (such as pregnancy, oral contraceptives, or hormonal shifts), genetics, and inflammation from conditions like acne or irritation. Dark spots can also develop after skin injury or inflammation, known as post-inflammatory hyperpigmentation (PIH).

Melasma is a chronic pigment disorder that typically appears as symmetric brown or gray-brown patches on the cheeks, forehead, upper lip, or jawline. It differs from PIH in that melasma is often hormonally driven and more prone to recurrence. Because melasma pigment sits deeper in the skin, it usually requires a more sustained and carefully managed treatment approach.

Treatment depends on the type and depth of pigmentation, skin sensitivity, and prior response to therapy. Dermatologists often use a combination approach, which may include:

• Brightening Cream (azelaic acid + niacinamide) to gradually improve uneven tone and reduce hyperpigmentation.

• Dark Spot Cream (hydroquinone + tretinoin + hydrocortisone) for stronger pigment suppression during appropriate treatment cycles.

Your dermatologist determines which option is best based on your skin type and goals.

The Dark Spot Cream combines hydroquinone to suppress excess pigment production, tretinoin to increase skin cell turnover, and hydrocortisone to reduce irritation and inflammation. This combination is often used in structured cycles to improve melasma and stubborn dark spots when clinically appropriate.

The Brightening Cream (azelaic acid + niacinamide) helps reduce pigment production, calm inflammation, and improve overall skin tone. It is often used as a gentler long-term option or in combination with other treatments to help maintain results and improve skin tolerance.

Tranexamic acid pills may be used in select patients as an oral option to help manage melasma and hyperpigmentation by affecting pathways involved in excess pigment production. It is typically considered alongside topical treatments and strict sun protection when clinically appropriate.

Most patients begin to see visible improvement after 8–12 weeks, but deeper or hormonally driven pigment can take longer. Consistency with treatment and sun protection is critical, as pigmentation disorders often improve gradually rather than quickly.

Sunlight, including visible light, can worsen melasma and reverse weeks of progress. Daily sunscreen use is essential and should be considered part of treatment, not optional. Many patients benefit from tinted sunscreens to better protect against visible light exposure.

Melasma and some forms of hyperpigmentation are prone to recurrence, especially with sun exposure or hormonal triggers. Maintenance therapy, sun protection, and avoiding known triggers help reduce the risk of relapse.

At EasyDerm, we recommend using the Dark Spot Cream for two months on, followed by one month off. This is because the dark spot cream contains hydroquinone, which is a very effective pigment-suppressing ingredient but should not be used continuously long term.

Using hydroquinone for extended, uninterrupted periods can rarely lead to a condition called exogenous ochronosis, where the skin develops paradoxical darkening. While this is uncommon, cycling treatment is a well-established dermatologic practice to reduce risk while maintaining results.

During the one-month break from the dark spot cream, we recommend switching to the Brightening Cream (azelaic acid + niacinamide). This helps:

• Maintain the progress achieved during the hydroquinone phase.

• Continue reducing inflammation and pigment production.

• Support skin barrier health and tolerance.

Using the brightening cream during the “off” month allows you to preserve results without exposing your skin to continuous hydroquinone.

No, when managed properly, most patients do not lose their progress. Cycling treatment between the dark spot cream and the brightening cream helps control pigment over the long term while minimizing risk. Consistent sunscreen use during both phases is critical to maintaining results.

Often, yes. Teledermatology works well when photos and history fit classic melasma or hyperpigmentation patterns. In-person evaluation may be recommended for changing or irregular pigmented lesions, or if there is concern for other skin conditions.