Why melasma is frustrating
Melasma is not just “dark spots.” It is a chronic pigmentation condition that can be triggered or worsened by sun exposure, visible light, hormones, pregnancy, and certain medications. The American Academy of Dermatology notes that melasma commonly appears as brown or gray-brown patches and is often influenced by sun exposure and hormonal factors.
Patients often make melasma worse by chasing aggressive exfoliation, heat-heavy procedures, or random brightening products before they have a plan for pigment control and relapse prevention.
The foundation is protection, not just treatment
Sun and visible light protection are central to melasma care. The American Academy of Dermatology recommends broad-spectrum sunscreen with SPF 30 or higher and notes that products with zinc oxide, titanium dioxide, and iron oxides may be especially relevant for melasma protection.
This is why a prescription cream alone is not the entire answer. Without consistent protection, melasma often returns or remains difficult to control.
What treatments may be considered
Melasma treatment may include topical medications such as hydroquinone, tretinoin with a mild corticosteroid, triple-combination cream, azelaic acid, kojic acid, vitamin C, and other approaches depending on the patient. The American Academy of Dermatology also notes that some patients may be treated with procedures or, in select cases, oral tranexamic acid when other treatments have failed.
The right plan depends on skin type, pregnancy status, breastfeeding status, prior reactions, pigment depth, irritation risk, and whether the diagnosis is truly melasma versus post-inflammatory hyperpigmentation, lentigines, drug-related pigmentation, or another condition.
Why diagnosis matters
Not all brown spots are melasma. Pigment can come from acne inflammation, sun damage, hormonal melasma, medication reactions, or other medical causes. Treating every pigment problem like melasma can lead to poor results, irritation, wasted money, and delayed diagnosis.
That is where dermatology review is valuable. The goal is to identify the pattern first, then match therapy to the diagnosis.
How CutisRx fits
CutisRx gives patients a more clinical pathway for melasma and pigmentation concerns. Patients choose the pigmentation pathway, complete the intake, upload photos, and receive board-certified dermatology review when clinically appropriate.
Available in eligible U.S. states except Alaska, Mississippi, and New Jersey.
FAQ
Can melasma be treated online?
Many pigmentation concerns can be reviewed online when photos and medical history are adequate. Some pigment problems still need in-person examination, dermoscopy, biopsy, procedures, or a different medical workup.
Is hydroquinone always needed?
No. Hydroquinone is one possible treatment, but melasma care may also include non-hydroquinone options, strict light protection, and other therapies depending on the patient.
Why does melasma come back?
Melasma often recurs because triggers such as ultraviolet light, visible light, heat, hormones, and inflammation may continue. Long-term control usually requires maintenance and protection, not just a short treatment burst.