Melasma - also called chloasma - is a dark skin discoloration found on sun-exposed areas of the face, neck and rarely the upper limbs. A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face). Prevention should target a reduction of exposure to risk factors, such as consistent protection against UV radiation.

Cause
Melasma is a very common skin disorder. Known risk factors include ultraviolet (UV) radiation, hormonal variations of pregnancy and thyroid disease, and anti-seizure medications. Though it can affect anyone at any age, young women with brownish skin tones are at greatest risk. Melasma is often associated with the female hormones estrogen and progesterone. Melasma is especially common in pregnant women, women who are taking oral contraceptives ("the pill"), and women taking hormone replacement therapy during menopause. Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates. The increase in melanin may be due to both an increase in melanogenesis and melanocytosis.

J Eur Acad Dermatol Venereol. 2013. Melasma pathogenesis and influencing factors - an overview of the latest research. Melasma is an acquired, symmetrical hypermelanosis of the face. The pathogenesis is complex and the treatment is often challenging with frequent relapses. Genetic background, exposure to ultraviolet radiation, and female sex hormones are classical influencing factors. To the light of the recent literature, other factors could promote melasma lesions. Moreover, there are increasing evidences showing that melanocytes are not the only cells involved, and that other players probably have a key role in the development and the relapses. Identifying those associated factors should provide new targets for a more efficient treatment of melasma and a better prevention of the relapses.

J Drugs Dermatology. 2014. Finasteride associated melasma in a Caucasian male.
Ann Dermatol. 2015. Melasma in a Male Patient due to Estrogen Therapy for Prostate Cancer.

Symptoms
Melasma doesn't cause any other symptoms besides skin discoloration but may be of great cosmetic concern.

Melasma treatment
The principle treatment options include topical hypopigmenting agents, chemical peels, laser therapy and superficial dermabrasion. Treatment involves sun blocks, bleach, and time. First-line therapy for melasma should consist of fixed triple combinations. Where patients have either sensitivity to the ingredients or a triple combination therapy is unavailable, other compounds with dual ingredients (hydroquinone plus glycolic acid) or single agents (4% hydroquinone, 0.1% retinoic acid, or 20% azelaic acid) may be considered as an alternative. In patients who failed to respond to therapy, options for second-line therapy include peels either alone or in combination with topical therapy. Lasers should rarely be used in the treatment of this skin condition. I am not aware of a melasma cure. A combination of tretinoin cream and a bleaching cream containing hydroquinone may be helpful in fading some types of melasma. Occasionally, chemical peels or topical steroid cream can be helpful. In severe cases, laser treatment can be used to remove the dark pigment. For temporary help, make up can be used. Salicylic acid peels are not effective in the treatment of melasma when added to twice-daily 4% hydroquinone cream.

There is a need to look for drugs that are superior to hydroquinone, as only then will they have a meaningful clinical utility. For now, a few drugs like deoxyarbutin, ellagic acid, dioic acid, n-butylresorcinol and azelaic acid have such properties in clinical trials, while metformin is a recent addition.

Do you not know that hydroquinone has been banned in the UK, Europe, South Africa and parts of Asia for it's toxicity, carcinogenic properties and scarring potential? That it causes melasma to come back much stronger after discontinued use and upon a subsequent courses? The FDA has not banned hydroxyquinone yet, but they will probably be up to speed in the next few years or so.
   I will look into this claim in detail before I answer it. If any dermatologists who treat melasma have an opinion regarding this comment, please email me.

Melasma: treatment with 10% tretinoin peeling mask.
J Cosmet Dermatol. 2010. Ghersetich I, Troiano M, Brazzini B, Arunachalam M, Lotti T. Department of Dermatology, University of Florence, Florence, Italy.
Tretinoin peeling mask can be considered an alternative treatment modality in treating melasma. We noted a particular high tolerability and efficacy without adverse events.

Natural melasma treatment -- home remedy
A natural treatment for melasma may be a combination of topical creams and oral supplements. A new treatment for melasma could include grape seed extract but much more research is needed. Other options are topical ellagic acid or arbutin, or orchid extract. I don't have personal experience in my practice with these alternative therapies, so I don't know how well they work. Glycolic acid is worth a try.

Grape seed extract
Phytother Res. 2004. Oral intake of proanthocyanidin-rich extract from grape seeds improves melasma.
Melasma, an acquired hypermelanosis, is often recalcitrant to various treatments and an amenable, as well as safe, pigment-reducing modality is needed. We investigated that the reducing effect of proanthocyanidins on melasma in a one-year open design study. Proanthocyanidin-rich Grape seed extract was orally administered to 12 Japanese woman candidates with melasma for 6 months. Clinical observation, L* value (lightening) and melanin index, and size (length and width) measurements of melasma were performed throughout the study period. The first 6 months of grape seed extract intake improved or slightly improved melasma in 10 of the 12 women and following 5 months of intake improved or slightly improved melasma in 6 of the 11 candidates. L* values also increased after grape seed extract intake. Melanin-index significantly decreased after 6 months of the intake, and also decreased at the end of study. Grape seed extract is effective in reducing the hyperpigmentation of women with melasma. The beneficial effects of grape seed extract was maximally achieved after 6 months and these was no further improvement after this period. The latter grape seed extract intake for 5 months may prevent melasma from becoming worse prior to the summer season. Grape seed extract is safe and useful for improving melasma.

I read on your website that grapeseed extract has been found to be effective for melasma (research study involving Japanese women patients with melasma). I have been under treatment (with no or slight and very short-lived improvement) for severe melasma for several years, most treatments involving topical creams with 4% HQ hydroquinone. I just started new treatment consisiting of bleaching and cleansing (topical) regimen as well as twice a month facial peels, all involving Kojic and /or Lactic acid. I am also using vitamin C cream and Finacea (for Azelaic acid). Being a post menopausal woman of South Asian descent, I have been discouraged from lasers and medium and deep peels, and so far nothing has really helped (the most recent treatment described above just started three weeks ago. I have been browsing the Internet for all I can learn about treatment for melasma, and came across your advice involving grapeseed extract. What strength and what dosage is recommended, and are we talking about capsules or grapeseed oil? Any long term negative effects that one needs to be concerned about?
   A. The ideal grapseed extract dosage, safety, and other matters with the use of this supplement are not yet fully understood since research in this area is still quite primitive. One option is to take one grape seed extract capsule of 100 mg daily.

A randomized, double-blind, placebo-controlled trial of oral procyanidin with vitamins A, C, E for melasma among Filipino women.
Int J Dermatol. 2009. Handog EB, Galang DA, de Leon-Godinez MA, Chan GP.
To assess the safety and efficacy of oral procyanidin + vitamins A, C, E among Filipino patients with epidermal melasma. A randomized, double-blind, placebo-controlled trial lasting 8 weeks, involving 60 adult female volunteers with bilateral epidermal melasma, Fitzpatrick skin types III-V, was conducted at the Section of Dermatology, Research Institute for Tropical Medicine, Department of Health, Manila, Philippines. Patients received either the test drug or placebo, twice daily with meals. In this 8-week trial period, oral procyanidin + vitamins A, C, E proved to be safe and effective among Filipino women with epidermal melasma.
   Procyanidin is also known as proanthocyanidin.

Ellagic acid and arbutin
Efficiency of ellagic acid and arbutin in melasma: a randomized, prospective, open-label study.
J Dermatol. 2008. Department of Dermatology and Pharmacy, Ege University School of Medicine, Izmir, Turkey.
The aim of this study was to compare the effectiveness of gel formulations containing arbutin, synthetic ellagic acid and plant extracts that contain ellagic acid, on patients with melasma. Thirty patients who applied to Ege University Medical Faculty, Department of Dermatology, were included in the study. Patients whose type of melasma was determined via Wood's lamp were randomized to groups of arbutin, synthetic ellagic acid and plant extract containing natural ellagic acid. A decrease in the level of melanin was determined in eight of these nine patients. A significant decrease in the level of melanin was also determined in all 10 patients who used plant extract containing ellagic acid. A significant response was obtained from all of 10 patients who used arbutin. Formulations prepared with plant extracts containing ellagic acid was found effective on melasma, similar to the formulations containing synthetic ellagic acid and arbutin. This material that is not yet being used widespread commercially on melasma could be an effective alternative for treatment of melasma.

I have a bad case of melasma and read the article regarding the use of aloesin and albutin in synergy to slow down the melanocytes. Do you sell this cream?
   Sorry, we don't have such as cream with aloesin and albutin at this time.

I plan to try grape seed extract and either ellagic acid or arbutin. Is the ellagic acid or arbutin more effective for melasma? I understand that both are applied topically - where do you recommend I purchase them for topical use? Note that I plan to buy Nutribiotic liquid grape seed extract, which I assume is high quality.
   I am not familiar with Nutribiotic Liquid grape seed extract. If you do a google search, you should find arbutin or ellagic acid creams.

Regarding the above email. This reader (and many many others from what I'm seeing on other forums) is confusing grape seed extract with grapefruit seed extract. The Nutribiotic product they are referring to is the grapefruit seed extract used as a natural antibiotic and available at every health food store. Since many people are familiar with the common grapefruit seed extract it might be a good idea to point out that the grape seed and grapefruit seed extracts are entirely different products with different properties and shouldn't be confused.
   Thank you for bringing this to our attention.

Orchid Extract
Whitening efficacy of plant extracts including orchid extracts on Japanese female skin with melasma and lentigo senilis.
J Dermatol. 2010. Neveu M, Ozawa K, Ikeda A, Nagamatsu M, Shinn S. Department of Dermatology, Osaka National Hospital, National Hospital Organization, Chuo-ku, Osaka, Japan.
The purpose of this study was to assess the in vivo efficacy of a cosmetic formulation containing plant extracts including orchid extracts, compared to 3% vitamin C derivative formulated with the same excipient, in Japanese female adult volunteers with melasma and/or lentigo senilis. Forty-eight female volunteers aged 30-60 years applied the plant extracts and vitamin C derivative to one side of the face. After 8 weeks of treatment, both the clinical evaluations by a dermatologist and the questionnaire surveys by volunteers indicated that the cosmetic formulation containing plant extracts was significantly effective in improving the size, brightness, color intensity, clarity, visibility and global appearance of the pigmented spots, and also the luminosity complexion and skin clarity of the face. The good agreement between the results of clinical evaluations and those of questionnaire surveys showed that the orchid-rich plant extracts possess efficacy similar to vitamin C derivative in whitening the skin as well as melasma and lentigo senilis on the face of Japanese women.

MSM cream
Does MSM cream help with melasma?
   I am not familiar with the use of MSM for this skin condition. MSM creams are available, however they are most often used for pain relief.

Pycnogenol pine bark extract
Phytother Res. 2002. Treatment of melasma with Pycnogenol. Thirty women with melasma completed a 30-day clinical trial in which they took one 25 mg tablet of Pycnogenol with meals three times daily, i.e. 75 mg Pycnogenol per day. After a 30-day treatment, the average melasma area of the patients decreased by 25 mm(2) and the average pigmentary intensity decreased. The general effective rate was 80%. No side effect was observed. Several other associated symptoms such as fatigue, constipation, pains in the body and anxiety were also improved.

Melasma prevention
Daily sunscreen use not only helps prevent it, but reduces the risk for wrinkles and skin cancer.