Melasma and hyperpigmentation: how to handle them effectively according to science.
Melasma is a particular form of hyperpigmentation, far more difficult to treat than sun spots or post-acne spots. This article deciphers the latest scientific data: mechanisms, skincare routine, lifestyle, but also peels, microneedling and laser. For product selection, BeautyDecoded algorithmic scores and feedback from the app's users are used to objectify each analysis.
Understanding melasma.
Melasma results from a disorder of the melanocytes, which begin to produce melanin in large quantities in specific areas: the forehead, cheekbones and upper lip. It mainly affects women.
Triggering factors include sun exposure, pregnancy or hormonal imbalance, skin inflammation linked to diet or poor cosmetics, and genetic predisposition. Its treatment is complex: all the more reason to rely on science rather than marketing superlatives.
A major breakthrough comes from a study published in 2019: contrary to what was previously thought, melasma is not just a disorder of melanocytes. It also involves keratinocytes, mast cells, skin inflammation and alteration of the basement membrane. (Kwon SH et al., 2019). It is by acting on all these mechanisms that we can hope to overcome them.
Fight melasma: five mechanisms to target.
To maximize the effectiveness of anti-stain treatments, five mechanisms must be considered simultaneously.
The basal membrane
Do not break the skin. A laser or peel that is too powerful will cause inflammation and rupture of this membrane, making melasma worse. Rushing is counterproductive.
Tyrosinase
Reduce the action of the enzyme that converts tyrosine into melanin. This is the pathway by which an increase in estrogen aggravates melasma. Several active ingredients target this enzyme.
Keratinocytes
Limit keratinocyte irritation: niacinamide slows melanin transfer to these cells.
Inflammation
Chronic inflammation - sun, diet, irritating cosmetics - aggravates melasma. The challenge is to act without irritating.
Mast cells
Sun exposure increases the number of mast cells, a major cause of hyperpigmentation. One active ingredient stands out here: tranexamic acid.
So there's no simple treatment that can knock out melasma: what's needed is a real change of habits. And the most effective measure is sun protection, because UV rays and visible light are the source of all these mechanisms.
Sun protection : the most effective measure.
Sun protection, yes, but not just any kind. Choose mineral sunscreens with zinc oxide, which protect against UVB and UVA rays. Tinted sunscreens are also recommended: they often contain iron oxides, which protect against the visible light emitted by the screens. Failing that, a BB cream containing iron oxides will do the trick, as more and more studies are establishing a link between visible light and melasma.
Another subtlety: some sunscreens are irritants, notably avobenzone and octocrylene. Irritation should be avoided in cases of melasma. Read the list of ingredients carefully, and observe your skin's reaction to each new product.
Your melanocytes have become «super melanocytes». A very short exposure is enough to reactivate them. Sun protection must therefore be daily, cover visible light, and be renewed every two hours outdoors.
The ingredients effective against melasma.
The active ingredients that regulate tyrosinase are hydroquinone, azelaic acid, glycolic acid and retinoids. Each has a corresponding level of scientific evidence, from 1 (maximum proven efficacy) to 5 (mere expert opinion without study).
Hydroquinone
Prescribed by the dermatologist as a magistral preparation combining several depigmenting agents. Not to be used over a long period, as it may cause serious side effects.
Azelaic acid
Reduces the action of tyrosinase. Derived from cereals (barley, wheat, rye), of synthetic origin in cosmetics. Also highly effective against acne and redness.
Glycolic acid
Diminishes the action of tyrosinase and is a useful complement to an anti-melasma routine, provided it is gentle enough not to irritate.
Tranexamic acid
Acts on both tyrosinase and the mast cells responsible for neovascularization. A 2019 study showed it to be as effective as topical hydroquinone, without its side effects (Kim SJ et al., 2019).
Niacinamide
Reduces melanin transfer to keratinocytes.
Vitamin C
Reduces free-radical inflammation, mitigates the effects of the sun and regulates melanocytes. Oral intake may even be beneficial.
Retinoids are highly effective: they shorten the cell regeneration cycle and regulate tyrosinase. The mistake to avoid would be to buy all these active ingredients at once and launch a complex routine: the skin won't tolerate it. It's better to proceed in stages to avoid creating inflammation.
Five anti-spot active ingredients under the microscope.
Since melasma requires that irritation be avoided, the sensitivity verdict (Dr David's rule) takes on particular importance here.
| Product | Note BD | Notice (n) | Key score |
|---|---|---|---|
| La Roche-Posay Mela B3 | 4,58 | 18 | Stains 90.1 - niacinamide + melasyl |
| Anua Niacinamide 10% + AT 4% | 4,55 | 10 | Spots 85 - sensitive +0.65 (better tolerated) |
| Aroma-Zone Azelaic Acid 10% | 4,32 | 19 | Imperf. 90.1 - low price - versatile |
| Geek & Gorgeous C Glow 15% | 4,76 | 48 | Blemishes & anti-aging 90.1 - vit. C morning |
| The Ordinary Granactive Retinoid 2% | 4,94 | 8 | Anti-ageing 76.5 - mild retinoid, evening |
La Roche-Posay Mela B3 - Anti-dark spot serum
This serum combines niacinamide with a patented active ingredient targeting melanin at source. Niacinamide reduces melanin transfer to keratinocytes, one of the five mechanisms of melasma. 90.1 spot score One of the best in the base. Sensitive skin score of -1.35, which suggests a slight degree of caution.
One of the highest spot scores, well-dosed niacinamide, outstanding results on scars and darker skin.
High price; patience required for mature skin; slight caution for sensitive skin.
A relevant option as a background anti-spot serum, to be introduced gradually. Feedback is particularly encouraging on acne spots and scars, especially on darker skins. The effect on established blemishes on mature skin requires more patience.
«Pleasant to use, faded my spots. The whole range is very good.»
«Spectacular on young skin with imperfections, visible results within a month.»
«On trial for two months, I haven't seen any results yet.»
Anua Niacinamide 10% + Tranexamic acid 4%
This serum combines tranexamic acid, the reference active ingredient for mast cells and melasma neovascularization, and niacinamide, which slows melanin transfer. Arbutin completes the depigmenting action. Spot score of 85 and positive sensitive skin score (+0.65) This is the best-tolerated formula in this selection, a major asset in melasma.
Tranexamic acid targeted at melasma, best tolerance of selection, excellent redness score.
10 % niacinamide sometimes too much for very sensitive skin; texture a little thick.
It's a relevant option, and particularly coherent with melasma: tranexamic acid targets a key mechanism, and tolerance is the best of the selection here. A preferred option for those who want to take action without risking aggravating inflammation. However, the niacinamide concentration at 10 % may be too high for the most reactive skins.
«Perfect if you have reactive skin, blemishes or melasma. Beautiful composition.»
«Effective on spots without aggressing, I prefer to apply it in the evening.»
«10% of niacinamide is a little too much for my sensitive skin.»
Aroma-Zone Azelaic Acid Serum 10%
Formula centered on azelaic acid, which regulates tyrosinase while acting on acne and redness. A versatile, affordable option. Imperfections score of 90.1, redness score of 68 and sensitive skin score of -0.5: good tolerance, with gradual introduction recommended.
Excellent value for money, dual action for spots and blemishes, good tolerance.
May fluff; gradual introduction necessary; not suitable for dry skin.
A relevant, cost-effective option for regulating tyrosinase and jointly treating blemishes and redness. Users confirm good overall tolerance, with possible linting: thin layer application and gradual introduction recommended.
«Doesn't irritate my skin at all, I treat my acne and blackheads gently.»
«Results from the first week: brighter skin, fewer imperfections.»
«Good value for money, but needs to be integrated gradually as it can fluff up.»
Geek & Gorgeous C Glow - Vitamin C 15%
A pure vitamin C serum at 15 %, stabilized by ferulic acid and vitamin E. Vitamin C reduces free-radical inflammation, attenuates the effects of the sun and regulates melanocytes. 90.1 spot and anti-ageing score, Apply in the morning. Sensitive skin score of -3: pure vitamin C remains a powerful active ingredient, to be introduced with caution.
Reference vitamin C for hyperpigmentation, complete formula, unbeatable price.
Not suitable for sensitive skin; sun protection essential after application.
A relevant option as a morning vitamin C, at a very affordable price, to support the fight against hyperpigmentation. To be introduced only once the routine has been well tolerated, and always under sun protection. The sensitive skin score of -3 means that it should be used with caution on reactive skin.
«An inexpensive and really effective vitamin C serum, light texture.»
«This could be my 20th bottle: you can't change a winning team.»
«Pleasant texture, but I didn't like the effect on my skin.»
The Ordinary Granactive Retinoid 21% Emulsion
This emulsion is based on a new-generation retinoid, reputed to be milder than conventional retinol. Retinoids shorten the cell cycle and regulate tyrosinase. Blemish score of 71.4 and anti-ageing score of 76.5. Sensitive skin score of -2.45: a retinoid remains an active ingredient to be introduced very gradually, but this one is preferred for its gentleness.
Mild retinoid ideal for beginners, with dual action on spots and anti-aging, affordable price.
Remain a retinoid: very gradual introduction, night-time use, mandatory SPF.
A relevant option for gently initiating a retinoid in an evening anti-melasma routine. Users describe it as ideal to start with, with little irritation. Introduce every second or third evening, never at the same time as other strong active ingredients, and always with sun protection the following day.
«Pleasant texture, perfect for a first retinol.»
«Very interesting to start retinol slowly, not irritating at all.»
«Use in the evening, leaves no greasy residue. Unbeatable price.»
Build your own anti-melasma routine, step by step.
The aim is to introduce the active ingredients one by one, without ever creating inflammation. Here's a reasoned progression.
First two days : SPF 50+ sun protection with zinc oxide and iron oxides every morning, serum with tranexamic acid and niacinamide, and moisturizer. Tolerance is observed.
Next: Introduce retinoid in the evening, after niacinamide, starting every other night or even every third night, then increasing slowly. A moisturizing cream should be applied before or after the retinoid.
Once the retinoid has been well tolerated : add vitamin C in the morning, just after cleansing, before niacinamide and tranexamic acid.
To find out more : incorporate azelaic acid in the morning, after vitamin C, once the latter has been perfectly tolerated.
A final principle, valid at every stage: choose cosmetics that are free of fragrances and irritants.
Estrogen
Estrogen plays a major role in the appearance of melasma. If yours appeared after the introduction of contraception, talk to your gynecologist about changing pills or methods.
Feeding
Limit everything that promotes skin inflammation, starting with your diet. Reduce sugar and unhealthy industrial fats as much as possible, and opt for a diet rich in antioxidants.
Peelings, microneedling and lasers.
Unlike other forms of hyperpigmentation, melasma requires non-aggressive techniques to avoid causing reactive hyperpigmentation - skin that darkens after a small wound or acne outbreak. Three main treatments are used: peels, microneedling and lasers. They accompany the preceding measures, but are not a miracle solution.
Peelings and lasers are best avoided in summer, with several sessions scheduled for winter. Peels should be gentle; glycolic acid, widely studied in melasma, can be combined with azelaic acid or kojic acid. Microneedling creates microchannels that facilitate the penetration of active ingredients. Non-abrasive lasers are preferred to avoid pigmentary rebound, and the procedure must be performed by a physician after skin preparation. Use extreme caution on dark skin.
In 2016, a Beverly Hills team proposed a three-phase treatment algorithm:
Sun protection and combination of topical active ingredients.
Addition of superficial peels and non-abrasive lasers.
Additional treatments: radiofrequency, Q-switch laser, IPL, microneedling.
Visit relapse Melasma fades in winter and returns in spring. Your melanocytes are out of whack, and a single day in the sun without protection can ruin an entire year's efforts.
You now have the cards in your hand, based on the latest scientific data. It's up to you to apply them, with patience and regularity.
Make your choice of anti-spot active ingredients objective with BeautyDecoded application.
BeautyDecoded is a mobile application for cosmetic analysis using artificial intelligence. It deciphers INCI formulations and generates compatibility scores for 80 skin types and profiles. It does not constitute a medical consultation, but enables you to objectively choose your anti-dark spot active ingredients according to a precise skin profile.
Discover the applicationYour questions about melasma.
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What is the BeautyDecoded application?
Information for educational purposes only. It does not replace a medical consultation. BeautyDecoded algorithmic scores do not prejudge the individual tolerance of each user: a test on a small area and, in case of doubt, the advice of a dermatologist are still recommended. Melasma and hyperpigmentation, particularly on dark skins, should be treated by a health professional; medical procedures (peels, lasers, microneedling) are the responsibility of a doctor. Opinions displayed are from BeautyDecoders and have not been verified. No commercial partnership links this page to the marquess mentioned. © BeautyDecoded - Independent information. Dr Sylvain David, Plastic and aesthetic surgeon - Founder of BeautyDecoded.