The patches faded, then came back. Is this something I will always have?
You did the treatment, or the pregnancy ended, or the summer passed, and the brown patches on your cheeks and upper lip faded. Then they returned, and nobody has told you clearly whether that is normal. It is, and this site starts there: what these patches actually are, what keeps bringing them back, whether they need treating at all, and the ladder of options from doing nothing upward — including what makes melasma worse.
Reviewed by Yongbo Jia, MD, head of dermatology at Chongqing West District Hospital. Melasma is chronic and relapsing: treatment lightens it and maintenance keeps it lighter, nothing removes it permanently, and no outcome is guaranteed.
Six things that bring melasma on and keep it there
Melasma is not caused by a dirty face, a bad cream or a failure of willpower. It comes from a small number of factors, most of which can be named and some of which can be changed.
Sunlight, and the light you can see
Ultraviolet light is the best-known trigger, and it is not the only one. Visible light — the ordinary daylight that comes through glass, and the glare from a screen or a bright window — can also drive pigment production in melasma. That is why a face can darken after a week indoors, and why protection has to mean more than a sunscreen applied once in the morning.
Hormonal change of any kind
Pregnancy is the classic setting in which melasma appears, and it can also arrive with hormonal contraception, with hormone replacement, and around the menopause. The pigment cells respond to hormonal signals, which is why the patches can appear during a pregnancy and fade afterwards, and why starting or stopping a hormonal medicine sometimes changes the colour of a face that had been stable.
A family tendency, and your skin tone
Melasma runs in families, and it is more common and more persistent in darker skin tones and in skin that tans easily. This is not a matter of care or of prevention: the same pigment cells that protect darker skin from the sun are the ones that over-react here. It does mean that treatment has to be planned around your skin tone rather than applied to it.
Heat, and inflammation in the skin
Cooking over a hot wok, saunas, hot yoga, a fever, and any procedure that leaves the skin inflamed can all darken melasma. Heat and inflammation are part of why some faces worsen in summer even when sun exposure is carefully managed, and part of why aggressive treatment can make the condition worse rather than better.
Medicines, and the thyroid
Some medicines make the skin more sensitive to light, and thyroid problems are seen more often in people with melasma than in the general population. A pigmentation that appears or darkens quickly after starting a new medicine, or alongside fatigue and weight change, deserves a medical look rather than another cream.
A barrier that has been over-treated
Years of scrubs, strong acids, frequent light-based sessions and unregulated lightening creams leave the skin inflamed and less able to tolerate anything. A damaged barrier holds pigment longer and reacts to treatment more unpredictably, which is why rebuilding it is often the first step rather than a cosmetic extra.
When a brown patch needs a doctor rather than a beauty counter
Most facial pigmentation is harmless and can wait for a planned assessment. Some of it should not wait, and the difference is usually visible. See a dermatologist rather than buying a lightening product if a patch is new, is changing in shape or colour, is asymmetrical, or sits on only one side of the face, because melasma is normally symmetrical and a one-sided lesion needs another diagnosis excluded. See a doctor if a pigmented spot bleeds, crusts, ulcerates or itches, if it is raised or nodular, or if it has a border that is irregular rather than soft. See a doctor if the darkening is rapid, or if it followed a new medicine or a change in hormonal treatment. See a doctor if the skin becomes persistently red, blistered or painful after a cream or a procedure, because that is injury rather than treatment. And see a doctor if the pigmentation comes with fatigue, weight change, or other general symptoms, since the skin may be reporting something that is being managed elsewhere in the body.
What a proper melasma assessment looks at
An assessment for facial pigmentation is not a glance in a magnifying lamp and a recommendation for a course of sessions. It is a set of questions whose answers decide what is driving the patches, whether they should be treated at all, and what would be safe for your skin.
Is this melasma, or something else?
Several conditions look like melasma and behave differently: sun spots, freckling, post-inflammatory marks after acne, and less common pigmentary disorders. Some of them need a different treatment and a few need a biopsy. Getting the diagnosis right is the whole basis of the plan, and it is the first thing an assessment should settle.
What pattern does it follow?
Melasma is usually symmetrical, and the pattern — across the cheeks, the centre of the face, the upper lip, or along the jawline — is a clue to what is driving it. A jawline pattern, for instance, is more often associated with hormonal factors, which changes what the plan should include.
What is driving it in your life?
The useful questions are practical: how much time you spend outdoors and when, whether you drive, whether you cook over high heat, what contraception or hormone treatment you use, what medicines you take, how you sleep and how much stress you carry. Treatment that ignores the triggers is treatment that gets undone every week.
How deep is the pigment?
Pigment sitting in the surface layer responds differently from pigment held deeper, and the two can sit on the same face. Examining the skin under different light is part of how the assessment judges this, and it is one of the reasons a plan cannot be made from a photograph.
What can you realistically maintain?
Melasma treatment only works for as long as it is kept up. Daily photoprotection, a topical routine and regular review are not optional extras at the end of the plan; they are the plan. A treatment that depends on a habit you cannot keep is a treatment that will fail, and saying so is part of an honest assessment.
What has already been tried, and what did it do?
Bring a list, including anything bought online and anything borrowed from a friend. Some treatments make melasma worse, some leave the barrier damaged, and an unregulated cream of unknown composition changes what is safe to do next. The history is often the most useful thing in the room.
From doing nothing, upward
Melasma treatment is a ladder, and the first rung is often to treat nothing at all and change what you are exposed to. Step one: find out what is driving it, and stop adding to it. Every plan begins with light and heat, because a face that is being darkened faster than it can be lightened will not respond to anything. Step two: protection, permanently. Broad-spectrum sun protection, applied generously and repeated, plus tinted protection that also blocks visible light, a hat, and a route that avoids the middle of the day. This step is the one that decides the long-term result, and it never stops. Step three: a topical routine. Topical retinoids, azelaic acid, hydroquinone, niacinamide, vitamin C and cysteamine are the substance classes used for melasma; they lighten gradually over months and they hold the improvement only while they are used. Step four: chemical peels. Glycolic, mandelic, lactic and salicylic peels, used gently and at long intervals, can lift surface pigment as an addition to a topical routine. Aggressive peeling irritates the skin and can darken it instead. Step five: light-based treatment, cautiously. Laser and light devices can improve melasma, and they can also inflame it and cause rebound darkening, especially in darker skin tones and at aggressive settings. This is a decision made by someone who treats melasma regularly, usually after the diagnosis and the triggers are settled, and often on a test area first. Step six: oral treatment. Oral tranexamic acid, as a substance class, is used in selected patients after assessment and is a medical decision rather than a cosmetic one. Step seven: maintenance. Whatever worked has to be continued at a lower intensity, indefinitely. Melasma is managed rather than cured, and the maintenance step is not the end of the ladder — it is the part that keeps the result.
The things people try that leave the face darker
Do not buy unregulated lightening creams. Products sold without a full ingredient list, particularly online and particularly ones promising rapid lightening, may contain potent steroids or mercury. Steroids on the face thin the skin, trigger acne and cause a withdrawal flare when stopped; mercury can leave pigmentation that is far harder to treat than what you started with. This is the single most damaging thing on the list. Do not let anyone treat melasma aggressively with laser. High energy, short intervals and stacked sessions inflame the skin, and in melasma that inflammation can bring the patches back darker than before. Rebound darkening after an aggressive laser is common enough that caution is the standard, not the exception. Do not sunbathe, use tanning devices or chase a tan. A tan may look briefly as though it has evened the skin out, but it works directly against every treatment on the ladder. Do not scrub, over-exfoliate or use strong acids daily. A damaged barrier holds pigment longer and reacts badly to treatment, and the irritation itself can darken melasma. Do not stack procedures. Peels, laser and microneedling in the same few weeks, or two clinics treating the same cheeks without knowing about each other, is a reliable way to end up with more pigment than you began with. Do not stop maintenance because the patches have faded. Fading is what maintenance looks like when it is working; stopping it is how the patches come back. Do not buy a package before an assessment. A course of sessions sold before anyone has looked at your skin, or a discount that expires today, is information about the seller rather than about your face.
The treatments this site keeps referring to
Melasma is treated with a small number of tools, and each has its own limits. Topical agents — topical retinoids, azelaic acid, hydroquinone, niacinamide, vitamin C and cysteamine — are the backbone, because they work slowly and can be continued for years. Chemical peels using glycolic, mandelic, lactic or salicylic acid lift surface pigment over a series of sessions, provided they are kept gentle. Light-based treatment, including intense pulsed light and laser, can improve pigment and can also provoke rebound darkening; it is planned around skin tone, settings and intervals rather than booked as a course. Oral tranexamic acid, as a substance class, is used in selected patients after assessment. Which of these belongs in your plan depends on the diagnosis, the depth and pattern of the pigment, your skin tone and what you can maintain — the assessment decides that, not the menu.
Why the patches appear, and what can be done
The causes on the left are the reasons melasma appears and keeps returning. The ladder on the right runs from doing nothing up to oral treatment and maintenance. Treatment lightens the patches; keeping them lighter is a permanent arrangement rather than a finished course.
The returning patches, in ten parts
Each guide answers one question people actually ask — what are these patches, why do they come back, do I need to treat them at all, what happens first. Read the two or three that match where you are.
The Brown Patches on My Face: What Melasma Actually Is
Melasma is not damage, an infection or something you did wrong. It is pigment cells following a louder signal than they should, and that changes what you do.
Read the guide →Why the Patches Come Back After They Fade
A good result that does not hold is the commonest complaint about melasma. The return is not a failure, it is how the condition behaves, and it is planned for.
Read the guide →What Sets Melasma Off: Sun, Visible Light, Heat and Hormones
The triggers are more varied than most people expect, and several are part of ordinary life. Knowing which apply to you is what makes a plan hold.
Read the guide →Can I Just Leave My Melasma Alone?
Melasma is not dangerous, and deciding not to treat it is a legitimate choice. What happens if you do nothing, and what treatment can change.
Read the guide →Where Do I Start With Melasma, and How Far Should I Go?
Melasma treatment runs from doing nothing through protection, topicals, peels and light-based work to maintenance. Where each step belongs, and when to stop.
Read the guide →What a Skincare Routine Can and Cannot Do About Melasma
A routine holds the result and helps the skin tolerate treatment. It does not clear melasma by itself, whatever the shelf says. Building one that helps.
Read the guide →Melasma cannot be cured — but it can be managed.
An assessment confirms the diagnosis, identifies your triggers, and sets out what treatment can realistically do and what maintenance will have to look like. We will say plainly that melasma relapses.
Frequently asked questions
Is melasma ever cured?
No. Melasma is a chronic, relapsing condition, and that is the honest starting point for everything else. Treatment can lighten the patches substantially and maintenance can keep them lighter, but the tendency remains. Anyone offering to remove melasma permanently is describing something that does not happen, and a plan built on that promise ends with disappointment and often with darker skin.
Will it fade on its own if I do nothing?
Sometimes, and it depends on the setting. Melasma that appeared during a pregnancy often fades in the months afterwards, and patches that are driven mainly by summer light commonly lighten in winter. Melasma that has been present for years rarely fades by itself, and it will darken again with light, heat or hormonal change. Doing nothing is a legitimate choice, but it should be a decision rather than a hope.
What is the single most useful thing I can do?
Protection from ultraviolet and visible light, used every day and continued indefinitely. It is the measure that decides the long-term result, and it matters more than which cream or which device is chosen. Broad-spectrum sun protection applied generously, plus tinted protection that also blocks visible light, a hat and shade during the middle of the day, is the whole of the first step.
Can laser make melasma worse?
Yes. Aggressive laser treatment can inflame the skin and cause rebound darkening, sometimes leaving the patches darker than they were before, particularly in darker skin tones. Light-based treatment still has a place in melasma, but it is a decision made after the diagnosis and the triggers are settled, with conservative settings and generous intervals, and often a test area first.
Are the lightening creams I see online safe?
Some are not. Products sold without a full ingredient list may contain potent steroids or mercury, which can thin the skin, cause acne, produce a withdrawal flare when stopped, and leave pigmentation that is harder to treat than the melasma itself. If a product promises rapid lightening and does not list its ingredients, that combination is a reason to walk away rather than to try it.
Who reviews the medical content on this site?
Every guide is medically reviewed by Yongbo Jia, MD, Deputy Director and head of dermatology at Chongqing West District Hospital. The review date appears on each article, and the site's own limits are set out in the health disclaimer.
Part of Uneven Skin Tone — 7 sites on this topic