1. What is melasma?
Melasma is an acquired, chronic hyperpigmentation that appears as brownish or grayish patches, usually symmetrical, in sun-exposed areas.
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2. What is the difference between melasma and other dark spots?
Melasma has a hormonal and solar origin and is symmetrical; solar lentigines (age spots) are small, round spots of aging; freckles are genetic and fade in winter.
3. Who is most at risk for developing melasma?
Women of childbearing age, pregnant women, users of oral contraceptives, people with darker skin types (phototypes III-IV), and those with a family history.
4. Can men get melasma?
Yes, although less common (about 10% of cases), men can also develop it, especially with intense sun exposure.
5. Is there a cure for melasma?
There is no definitive cure, but with continuous treatment and strict sun protection, it is possible to lighten and keep it controlled.
6. What makes melasma worse?
Sunlight, heat, visible light (cell phone screens, lamps), stress, hormonal fluctuations, and harsh cosmetics.
7. Is sunscreen really essential?
Yes, it is the pillar of the treatment. It must be used every day, even indoors or on cloudy days, with SPF 50+ and protection against visible light (tinted or with antioxidants).
8. What is the best sunscreen for melasma?
Physical sunscreen (titanium dioxide, zinc oxide) or broad-spectrum chemical sunscreen with UVA/UVB and visible light protection. Minimum SPF 50.
9. Can I use foundation or powder over sunscreen?
Yes, makeup with sun protection is welcome, but it does not replace sunscreen. Apply sunscreen before foundation.
10. Does thermal water help with melasma?
Not directly. It hydrates the skin but does not lighten it. It can be used as a complement.
11. Which lightening creams are effective?
Hydroquinone (with prescription), kojic acid, azelaic acid, arbutin, topical tranexamic acid, vitamin C, and retinoids.
12. Is hydroquinone dangerous?
In an appropriate concentration (2-4%), with supervised use and for a limited time (up to 3-4 months), it is safe. Prolonged or indiscriminate use can cause ochronosis.
13. Can I use hydroquinone on my own?
No. It must be prescribed by a doctor, with an evaluation of the phototype and follow-up.
14. Do chemical peels work for melasma?
Yes, superficial and medium peels (glycolic, mandelic, low TCA) help to exfoliate and lighten. Deep peels are contraindicated in darker skin.
15. How many peel sessions are needed?
On average 4 to 6 sessions with intervals of 15 to 30 days, depending on the response.
16. Can laser treat melasma?
Non-ablative fractional lasers and intense pulsed light (IPL) can help, but there is a risk of worsening in higher phototypes. Evaluated on a case-by-case basis.
17. Does microneedling with lightening actives work?
Yes, it is an excellent option for resistant melasma, as it creates microchannels that facilitate the penetration of lighteners.
18. Do collagen biostimulators help melasma?
Indirectly, they improve skin quality and can enhance lightening, but they do not act directly on melanin.
19. Is there oral medication for melasma?
Oral tranexamic acid (with prescription) has shown good results in moderate to severe cases. Also, supplements like Polypodium leucotomos.
20. What is the difference between epidermal, dermal, and mixed melasma?
Epidermal: light brown spot, responds well to treatments. Dermal: grayish, deeper, difficult to lighten. Mixed: a combination.
21. How do I know my melasma type?
Through a Wood's lamp examination (a simple test performed in the office).
22. Can pregnant women treat melasma?
During pregnancy, only sunscreen and safe topical care (azelaic acid, low glycolic acid). Hydroquinone and lasers are contraindicated.
23. Can I get treatment while breastfeeding?
Yes, with safe substances. Consult your dermatologist for guidance.
24. Do birth control pills worsen melasma?
Yes, hormones can trigger or aggravate it. Switching to a progestin-only pill or a non-hormonal IUD can help.
25. Will stopping birth control make melasma disappear?
It may lighten, but the spots usually do not disappear completely because the sun has already fixed the pigmentation.
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26. Does melasma return after treatment?
Yes, it is chronic. Maintenance with sunscreen and intermittent use of lighteners prevents its return.
27. Does diet influence melasma?
Indirectly. A diet rich in antioxidants (fruits, vegetables) and low in inflammatory carbohydrates can help control it.
28. Does stress worsen melasma?
Yes, because it increases cortisol, which can stimulate melanin production.
29. Does melasma itch or hurt?
It is usually asymptomatic. If there is itching, it may be associated contact dermatitis.
30. Is there a blood test for melasma?
There is no specific test. Hormones (TSH, estradiol) can be evaluated if an alteration is suspected.
31. Can melasma turn into skin cancer?
No. Melasma is benign; it does not transform into melanoma or carcinoma.
32. Are sun spots (lentigines) different from melasma?
Yes, they are accumulations of melanocytes due to chronic sun exposure, usually small and multiple. Treatment is similar, but they respond better to laser.
33. Is post-acne hyperpigmentation the same as melasma?
No. It is a spot that appears after inflammation (pimple, wound). It tends to fade over time and with lighteners.
34. Does retinoic acid lighten spots?
Yes, it stimulates cellular renewal but can cause irritation. It must be used with caution.
35. Does topical vitamin C work?
Yes, it is an antioxidant and inhibits tyrosinase (the melanin enzyme). Prefer stable formulations.
36. Can I get a deep facial cleansing if I have melasma?
Yes, provided there is no excessive mechanical aggression (avoid strong exfoliation). Gentle cleansing is beneficial.
37. Is using a dermaroller at home safe?
Not recommended. It can cause infection, scarring, and worsen the spots if not done in a medical setting.
38. Do home remedies (lemon, baking soda) work?
No, they are irritating and can worsen melasma, causing inflammation and rebound hyperpigmentation.
39. Is melasma related to liver problems?
There is no scientific proof. The term "liver spot" is popular, but it is a myth.
40. What is the difference between lightening and depigmentation?
Lightening reduces the intensity of the spot; depigmentation completely eliminates the color (used in vitiligo, not in melasma).
41. After lightening, can I stop using sunscreen?
No. Without protection, the spot returns in weeks.
42. Is it possible to completely clear melasma?
Rarely. The goal is to make it barely noticeable, not to eliminate it 100%.
43. Can a child have melasma?
Very rare. Spots in children are usually other conditions (nevi, café-au-lait macules).
44. Is combined treatment better?
Yes, the association of sunscreen + topical lightener + procedure (peel or microneedling) brings better results.
45. How long does it take to see results?
With sunscreen and cream, initial improvement in 4-8 weeks. With procedures, it can be faster.
46. Does melasma prefer any race?
More common in Latinos, Asians, and people with darker skin (phototypes III to V).
47. Can I wear makeup during treatment?
Yes, oil-free makeup with sun protection is ideal.
48. What is the difference between glycolic and mandelic acid?
Mandelic is gentler and better for darker and sensitive skin; glycolic penetrates deeper and is more irritating.
49. Is there a vaccine or injection for melasma?
No. Injectable tranexamic acid is used off-label in some cases, but it is not a vaccine.
50. How can I schedule an evaluation?
The clinic is located in Brazil. Consultations and treatments are provided by Dr. Caroline Minchio in person.