Melasma

What is Melasma?

Melasma is a chronic, acquired disorder in which patches of extra pigment develop on the skin, mostly on the face. It affects women more often than men and has a significant effect on quality of life.^{[1, 2]}

Common symptoms

The main sign is a flat brown or gray-brown patch with irregular edges, usually on the cheeks, forehead, upper lip or nose and often on both sides of the face. Melasma does not usually itch or hurt, but its appearance can cause distress.^{[1, 3]}

Doctors often describe melasma as epidermal, dermal or mixed, depending on how deep the pigment sits. Choosing treatment after a Wood's lamp or dermatoscope exam can help match the treatment to the type.^[4]

Causes and risk factors

Melasma is multifactorial. Sun exposure, sex hormones and pregnancy, and skin inflammation play a part in people who are genetically predisposed, and the pigment cells in affected skin are overactive.^[3] Melasma is more common in people with darker skin types, with a prevalence reported between about 9% and 40% depending on the population.^[4]

How it is diagnosed and treated conventionally

Diagnosis is usually made by a dermatologist from the appearance of the skin, and a biopsy is rarely needed.^{[3, 4]} Treatment is challenging because melasma is chronic and tends to return.^[4]

Hydroquinone alone and triple combination cream (hydroquinone, tretinoin and a corticosteroid) are the most effective and best-studied treatments. Chemical peels and laser or light devices are equal or inferior to creams with a higher risk of side effects, and oral tranexamic acid is a promising option for moderate to severe recurrent melasma that needs more long-term safety data.^[1] Combination therapy generally gives the best results, and recurrence is common with all treatments.^[4] Sun and visible light protection is part of every plan.^[2]

Why Melasma calls for a whole-person approach

Melasma is more than a surface problem. It reflects the skin's response to light, hormones, inflammation and the person's genetics, and it is chronic, so long-term habits and emotional wellbeing matter as well as creams.^{[2, 3]}

Care that supports the whole person is a reasonable partner to dermatology treatment, though it has not been shown to replace it.

Sun and light exposure

Solar radiation is a main external trigger for melasma.^[3] Visible light photoprotection is now part of treatment, so day-to-day sun habits matter.^[2]

Hormones

Sex hormones and pregnancy are recognized triggers, which fits the way melasma often appears in pregnancy or with hormonal medicines.^[3] Any hormone question belongs with your physician.

Skin inflammation and irritation

Skin inflammation, such as contact dermatitis or cosmetic procedures, can contribute to melasma, so harsh products and aggressive treatments can backfire.^{[3, 4]}

Stress and mood

A meta-analysis of 16 studies with 2,963 patients found that about 43% of people with melasma had depression, a high rate with substantial variation among studies. The authors recommend screening and psychosocial support.^[5]

Acupuncture for Melasma

What the research shows

Research suggests acupuncture may help, but the evidence is limited by study quality. A 2025 meta-analysis of 22 studies with 1,644 participants found acupuncture outperformed Western medicine and other treatments on overall effective rate and reduced lesion area and color. All the secondary outcomes were rated very low quality, and the authors cautioned about publication and regional bias.^[6]

An earlier review of eight trials with 587 women found acupuncture groups did better than comparison treatments such as tranexamic acid, vitamins and creams in seven trials. The trials were too varied to pool, and the authors concluded there was insufficient evidence for firm conclusions.^[7] A broader review of acupuncture in dermatology also covered chloasma, as melasma is sometimes called, and called for better-designed trials.^[8]

Among individual trials, 135 patients treated with acupuncture, with or without auricular acupressure, had higher effective rates than those given vitamins C and E.^[9] The comparison group received vitamins, and the trial did not use sham acupuncture.

How acupuncture may work

The mechanism is not established. In one trial, estradiol fell and progesterone rose after acupuncture, which the authors linked to hormone effects, but this is a single finding and does not prove how acupuncture affects pigment.^[9]

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the body and sometimes the face, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. In the 2025 meta-analysis, the most common needling sites were the facial lesion area and points such as SP6, LI4 and SP10.^[6]

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000.^[10] Facial bruising can be noticeable. Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Melasma

The Ayurvedic view

In Ayurveda, facial pigmentation is described as Vyanga, a traditional category in which Pitta and blood are said to become disturbed, often with stress, strong emotion and digestion issues. This is a traditional framework, not a biomedical diagnosis.

Therapies that may be used

Care is individualized and traditionally may include:

• Cooling diet and regular meals, limiting very spicy, sour or fermented foods
• Stress-reducing practices such as breathing exercises and regular sleep
• Herbal pastes and oils applied to the skin, with transdermal medication therapy as a related option in our clinic; no study supports a benefit of these for melasma
• Herbs taken by mouth, prescribed individually

Panchakarma is not appropriate during pregnancy, acute illness or frailty. Ayurvedic products also need careful sourcing: about one fifth of those bought online contained detectable lead, mercury or arsenic.^[11] Skin products need careful patch testing, because irritation can worsen melasma.^[3]

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic treatment for melasma in PubMed. Whether Ayurvedic therapies change melasma is unknown. Any benefit may be for stress, sleep or general well-being, and not for the pigment.

Herbal medicine for Melasma

Herbs and formulas that have been studied

Studied plant-based options include Polypodium leucotomos, a fern extract taken by mouth, silymarin from milk thistle and lycopene from tomato, along with topical plant extracts.^{[12, 13, 14]} In Chinese medicine, melasma is described by patterns such as liver qi stagnation, spleen deficiency and kidney yin deficiency, and combinations of herbs and acupuncture are used. Doses and formulas are individualized.

What the research shows

The evidence is limited. A systematic review of eight randomized trials of oral agents found that Polypodium leucotomos extract, along with tranexamic acid and others, appeared helpful, but the trials were few.^[12] A 2025 review of antioxidants found mixed results for Polypodium and effective-looking results for silymarin and lycopene as adjuncts, while noting varying study designs.^[13] A review of Polypodium noted that human studies are small.^[14]

For Chinese herbs, a trial of 61 patients found that adding herbs and acupuncture to vitamins C and E and a topical powder produced a higher effective rate than conventional treatment alone. It was small and not blinded to a sham.^[15] A 49-patient placebo-controlled trial in Iran found that a topical cream made from Dorema ammoniacum gum lowered a melasma severity score over 30 days.^[16] These results are early and have not been replicated at scale.

Safety and herb-drug interactions

Plant products used for pigment disorders have been linked to side effects. A systematic review reported blistering, redness and liver problems with some plants, and noted that trials often measure safety poorly.^[17] Herbs can also interact with medicines, including enhanced bleeding with warfarin and danshen, garlic or ginkgo, and lowered levels of some drugs with St John's wort.^[18]

Product quality matters too. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[11] Tell us if you are pregnant or breastfeeding, take hormonal medicines, or have liver or kidney disease. Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

These links are interpretation, not equivalence. Chinese medicine ties melasma to stagnation of liver qi and disturbed blood, which is often linked to stress and women's cycles. Researchers instead study overactive pigment cells, sun-driven signaling, sex hormones and skin inflammation.^[3] One acupuncture trial measured sex hormone changes, which loosely parallels the traditional focus on the liver and cycle.^[9]

Ayurveda's aggravated Pitta describes heat and a reactive state of the skin. Researchers study oxidative stress and antioxidants in melasma, an idea that loosely resembles the traditional use of cooling and antioxidant-rich remedies.^[13] No study has shown that a pattern or dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for melasma is complementary. Keep your dermatologist, keep up daily sun protection and any prescribed creams, and do not stop or change prescribed treatment without your prescriber. We do not diagnose skin conditions, so a new or changing dark patch should be examined by a clinician.

Please bring your diagnosis, a list of the creams, medicines and supplements you use, including hormonal medicines, and any treatments you have had, such as peels or lasers. Tell us if you are pregnant or planning pregnancy.

When to seek urgent medical care

Most melasma is not harmful, but some skin changes need prompt evaluation.^[4]

• A dark patch that is raised, bleeds, changes quickly or has uneven color and borders
• A new patch on one side only or in an unusual place
• Severe redness, blistering or swelling after a cream, peel or herbal product
• Persistent low mood or loss of interest linked to how your skin looks^[5]
• Yellow skin or eyes, or dark urine, after starting an herbal product

If you have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline. For emergencies such as trouble breathing or facial swelling, call 911 or go to the nearest emergency department.