Why does melasma need a two stage regimen?

The reason you need to alternate between 2 skin care routines is that you will use the Melasma Treatment Routine for 3-4 months and then switch to the Melasma Maintenance Routine.

Dermatologists may refer to the maintenance routine, as "taking a holiday from tyrosinase inhibitors." This holiday is necessary because your skin stops responding to tyrosinase inhibitors after a few months. If you take a break of 2-4 weeks from the tyrosinase inhibitors, they will work much better when you restart them.

Maintenance Routines don't have tyrosinase inhibitors in them.

Take the quiz and the regimen builder will help you choose the right products for your Melasma Treatment Routine. Use that for 3 months or until the dark spots disappear.

After you complete the first 3-month cycle of your Melasma Treatment Regimen you will switch to the Melasma Maintenance Regimen for 4 weeks.

At the end of 4 weeks, if you still have dark spots, you will restart the Treatment Regimen for cycle #2.

You will continue this 3-month / 4-week alternating cycle until the spots disappear. It may take 3- 4 cycles if melasma is severe, dark, or very deep in the skin.

Melasma may recur. If the dark spots come back, you use the Melasma Treatment Regimen when the dark patches are visible, and the Melasma Maintenance Regimen to prevent melasma from coming back. Always take a 4-week break from the Treatment Regimen every 3 months.

The steps involved in the Melasma Treatment skincare routine depend upon your Baumann Skin Type®.

 Here is an example of how treating melasma in sensitive skin differs:

All Five Steps in order (first phase, treatment)

Step 1: For both AM and PM the first step in your melasma treatment is a cleanser. The best cleanser for you depends on your skin type. Learn more about melasma cleansers here.

Step 2: For both AM and PM, the second step in your melasma treatment is an eye cream. Click here to learn how to choose an eye cream.

Step 3: For both AM and PM, the third step in your melasma treatment is a skin lightening ingredient. We advise using products that contain tyrosinase inhibitors, PAR-2 blockers, and antioxidants like Vitamin E. Anti-inflammatory ingredients are also very good for melasma treatments, as inflammation can lead to hyperpigmentation.

(Tyrosinase inhibitors are the most important ingredients to use because they prevent melanin production. Hydroquinone (only available by prescription), kojic acid, arbutin, and licorice extract are examples of tyrosinase inhibitors.  PAR-2 blockers such as niacinamide interrupt the pigmentation process by preventing the transfer of melanin-filled melanosomes into skin cells.) 

Here are some of the skincare products that our dermatologists recommend using in step 3 of your Melasma Treatment Routine:

If you have Dry skin and Melasma choose from these:

If you have Oily skin and Melasma choose from these:

Step 4: For both AM and PM, the fourth step of your melasma treatment is a moisturizer. Moisturizers are crucial for melasma treatments because they increase the efficacy of your skin lightening products. Occlusive moisturizers increase ingredient absorption.

Step 5: (AM) Step five of your melasma treatment regimen varies between AM and PM. In the morning, your fifth step is to apply a sunscreen, this is extremely important.

Step 5: (PM) Your fifth step in the treatment stage of your melasma treatment at night is a retinoid. Retinoids should only be used at night because they usually react to sunlight and UV radiation. Retinoids increase exfoliation, which results in the removal of dark spots from the skin. Be sure you're aware of the side-effects of retinoids.

To learn more about when to use retinoids in your skincare routine because when you use retinoids (before and after other ingredients) this will affect how well they work and impact side effects.

These are the five steps to the first stage of your melasma care. This is the routine you will follow for the first few months of your melasma care before you switch to the maintenance stage.

These are the best retinoids to get started with when beginning a new melasma skincare routine:

The Melasma Treatment skincare routine should be used for 12- 16 weeks; either until the dark spots are gone or for a maximum of 16 weeks. Once the melasma is clear, or it has been 3-4 months, change your skincare routine to the Melasma Maintenance Regimen for 4 weeks. If the melasma is still there at the end of 4 weeks, restart the Melasma Treatment Regimen.

You will rotate between 3-4* months of the Melasma Treatment Skin Care Routine and 4 weeks of the Melasma Maintenance Skin Care Routine until the melasma clears.

*The reason we say 3-4 months is sometimes it takes a while to acclimate to your retinoid. If you are using the retinoid every night- then 3 months is sufficient. If you are using the retinoid every other night or every third night, then follow a 4-month treatment regimen for the first cycle. Follow these retinoid instructions so you understand how to increase the strength of your retinoid every month.

The second stage regimen of melasma care; maintenance

Between the first stage of your melasma care and the second stage, only one step changes in your daily regimen; the third step.

The Melasma Maintenance skincare routine should contain anti-inflammatory agents to soothe the skin and antioxidants to protect the skin. If you have dry skin and melasma, the melasma skin care routine will contain hydrating moisturizers because dehydration can cause inflammation, which can cause the melasma to recur.

If you have mature skin, the melasma skin care routine will contain anti-aging ingredients. If you have sensitive skin, the melasma skin care routine will use gentle, soothing ingredients.

Keep in mind that steps 1, 2, 4, & 5 are the same for both stages of your melasma routine, meaning you don't need to buy two sets of products.

Both stages of your melasma routine should include 6 products in total. This covers the 5 steps of the first stage, and the third step on the second stage.

The difference between a melasma treatment regimen and a melasma maintenance regime is step 3. You want to remove the tyrosinase inhibitors and replace them with a skin-lightening ingredient from another category like a PAR-2 blocker.

Most of the time dermatologists recommend a Vitamin C serum for Step 3 of the maintenance regimen. 

Note that although Vitamin C technically has some tyrosinase inhibiting abilities, they are not very strong, so I do not consider Vitamin C a true tyrosinase inhibitor. Ascorbic acid (Vitamin C) works better in a melasma maintenance regimen than in a treatment regimen since it has strong antioxidant properties and can protect skin from the sun that sneaks through sunscreen.

The best Vitamin C Products To use in Your Melasma Maintenance and Prevention Routine are these:

Dermatologists recommend that after completing a 3 to 4-month Melasma Treatment Regimen using skin-lightening ingredients, you should take a 4-week ‘holiday’ and switch to the Melasma Maintenances and Prevention Skincare Routine discussed above.

After the 4 weeks is over, the Treatment Regimen can be restarted. You should continue this cycle until the melasma is resolved.

If your melasma clears sooner than 4 months, take the melasma skin care routine holiday when the dark patches disappear and do not restart your treatment regimen unless the melasma returns. If your melasma seems “cured”, your skin type has improved and you no longer need to be on a melasma skin care routine. Retake the Skin Type Quiz to find out what your new and improved melasma-free Baumann Skin Type® is and receive an updated skincare routine to address your skin concerns.

No matter what your melasma skin care routine is, you must wear sunscreen all day, every day - even on cloudy days - to protect your skin from all forms of light, including blue light and ultraviolet light. Tinted mineral sunscreens are the best choice because the iron oxide pigments help protect your skin from blue light on your phone that regular sunscreens do not block. (Yes your phone can worsen your melasma!)

These are our favorite tinted sunscreens to treat melasma (tinted sunscreens work best on melasma because they contain iron oxides which block light from your computer screen and phone).

In sensitive skin types who have melasma, inflammation is playing a role in causing skin pigmentation. There are 4 Baumann Skin Types that have skin sensitivity and melasma. You can see in the image below that each of these skin types needs different skincare products. Dry skin must be soothed and hydrated with barrier repair moisturizers before using any skin lightening ingredients or more inflammation will occur worsening melasma. Antiaging ingredients should be chosen carefully when skin is sensitive to prevent inflammation and worsening pigmentation.

If you have very sensitive skin, you will need to complete a soothing skincare routine with anti-inflammatory ingredients to prevent inflammation and irritation from the skin-lightening products.

There is no cure for melasma, but you can keep it under control by rotating between the following melasma treatment skincare routines and adopting good lifestyle habits, such as a daily SPF, sun protective clothing, a healthy diet, and stress reduction. Vitamins and supplements may also help melasma, but will not work well without a good skincare routine and consistent sunscreen use.

The number of cycles that it takes to clear melasma depends on:

1. How deep the melasma is in the skin
2. How compliant you are with your melasma skin care routine
3. Your amount of sun exposure and sun avoidance
4. Your amount of heat exposure
5. Whether you wear an SPF all day, every day
6. Your estrogen levels (higher estrogen levels worsen melasma)
7. Your stress levels
8. What supplements and vitamins you're taking

Any questions? Come ask us on social media.

1. Baumann L. Chapters 14, 20 and 41 of Baumann's Cosmetic Dermatology Ed 3. (McGraw Hill 2022)
2. Baumann, L. Chapters 32-45.  Cosmeceuticals and Cosmetic Ingredients (McGraw Hill 2015)
3. Gold, M., Rendon, M., Dibernardo, B., Bruce, S., Lucas-Anthony, C., & Watson, J. (2013). Open-label treatment of moderate or marked melasma with a 4% hydroquinone skin care system plus 0.05% tretinoin cream. The Journal of Clinical and Aesthetic Dermatology, 6(11), 32.
4. Taylor, S. C., Torok, H., Jones, T., Lowe, N., Rich, P., Tschen, E., ... & Ramirez, N. (2003). Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. CUTIS-NEW YORK-, 72(1), 67-73.
5. Torok, H., Taylor, S., Baumann, L., Jones, T., Wieder, J., Lowe, N., ... & Weiss, J. (2005). A large 12-month extension study of an 8-week trial to evaluate the safety and efficacy of triple combination (TC) cream in melasma patients previously treated with TC cream or one of its dyads. Journal of drugs in dermatology: JDD, 4(5), 592-597.
6. Baumann, L. Production of Melanin. Cosmetic Dermatology, 98.
7. Baumann, L. S. (2007). Hydroquinone. Skin & Allergy News, 38(2), 28-30.
8. Baumann, L., Rodriguez, D., Taylor, S. C., & Wu, J. (2006). Natural considerations for skin of color. Cutis, 78(6 Suppl), 2-19.
9. Baumann, L. (2016). Cosmeceuticals in skin of color. , 35, 4, 35(4), 233-237.