How a top dermatologist treats her melasma

For Dr. Alexis Granite, there has been one upside to mandatory mask-wearing: “It covers up the melasma on my upper lip. I’m a dermatologist and people come to me to have great skin, and then I have this ‘moustache’ of pigmentation. I hate it,” she says with real passion. “It just came on, and then over the past two years I feel it’s gotten worse. From being faint and only noticeable in the sun, now it never really goes away completely. But I’ve learned how to get on top of it; while melasma is difficult to manage, it’s about knowing how to control it.”

With her insider’s knowledge on the treatments that work (and those that can make it worse), Dr. Granite shares the creams, regimen and machines that helped fade her melasma – and can do the same for you, too.

“Melasma is most common in women aged about 20 upwards, particularly those with darker skin tones. It also tends to have a hormonal trigger, like pregnancy or the birth-control pill. Then again, there can be no identifiable trigger at all,” explains Dr. Granite. “Sun plays a huge role and can contribute to its onset, but while it’s a pigmentation problem, it’s much more difficult to treat than regular pigmentation. It looks different from freckles or sunspots as it tends to have a patchy border and is present in a bigger area, mainly on the face. It looks brown but it can have a gray tone, too – mine often appears gray.”

“Melasma can be more stubborn than regular pigmentation and certain treatments can potentially make it worse, so you need to see someone experienced. IPL [intense pulsed light] treatment is good for regular pigmentation, but I just did some on myself for my melasma and I’m convinced I’ve made it worse.”

“Unfortunately, I think it’s difficult to try to manage melasma yourself at home. It’s the same with acne – you need to get expert advice on a rolling regimen. However, the products you use at home will help to support any treatment plan. Your number one non-negotiable is SPF. I recommend a mineral sunscreen, as I think they are a bit more effective for melasma, and ensure you wear SPF45 or 50 every day. Any exposure to the sun – even through cloud – will darken it, as can heat (that includes hot yoga and saunas). I always advise clients to wear a hat, too. Look for skincare products that treat pigmentation, as these help melasma, and the more widely used ingredients to look for include kojic acid, arbutin, azelaic acid and tranexamic acid. Gentle exfoliation is fine, but don’t overdo it and aggravate the skin, especially on darker skin tones. You can do some light at-home microneedling, and LED red light is good, but be careful of generating any heat.”

“Do consider using some prescription creams at home, as melasma needs a multi-prong approach. Prescription retinoids, such as Ketrel (retin-A), are good for maintenance. I alternate this with another prescription cream, Pigmanorm, which combines hydroquinone, a retinoid and a mild topical steroid, and is very effective. But you must be consistent and stay with it, as it takes a couple of months to work. I also take an oral form of tranexamic acid before and after going on vacation – it’s a regimen that works well.”

“There’s no one treatment for melasma, or anything that makes it go away for good. It’s really frustrating, as you can have a course of IPL treatment or in-clinic peels and it’s all great, and then three months later it’s back. It’s about maintenance, having expert advice, the right treatments, wearing daily SPF and using pigmentation-targeted skincare. A course of clinical peels using a cocktail of specific acids is good, especially if you’re also using prescription creams at home. The Dermamelan peel is one of my favorites; there’s real downtime when your skin is red and peeling, but it gives great results. Cosmelan is the less-invasive alternative, and laser is another option, but I’m always hesitant to recommend it unless my clients have tried everything else, because it can make things worse further down the road.”

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