In 2023, former actor turned author Twinkle Khanna, revealed her experience with melasma, calling it an “uninvited guest” that appeared during her second pregnancy. Talking about it on her Tweak video, the now 52-year-old said that she developed melasma after her family trip, and instead of souvenirs, she came back with a melasma flare‑up, describing it as a “bin bulaya mehman” (an uninvited guest). She made a joke about how she now feels compelled to tell every pregnant woman she meets to use tranexamic acid, niacinamide and sunscreen, because these products help prevent this difficult skin discoloration. Her open discussion has enabled numerous women to recognize that melasma affects many people without causing harm, while it creates emotional challenges, which require appropriate medical treatment. Let’s learn more…What is melasmaMelasma is a common skin condition where patches of skin become darker than the surrounding area, usually on the face. The medical term for this condition is chloasma, because it appears mostly during pregnancy, but it also affects women who use birth control pills, hormone therapy and also men.
In this condition, the dark skin areas show brown or gray‑brown colors, which appear on the cheeks, forehead, nose bridge, upper lip and chin areas. The condition of melasma does not cause any pain, does not itch, is neither contagious or cancerous, so it only affects appearance. The condition which affects facial skin causes people to lose their self-assurance, because they become embarrassed by their physical appearance.
What causes melasmaThe skin condition Melasma develops when melanocytes which produce skin pigment, become hyperactive to create excessive melanin production. Experts don’t know exactly why this happens in every case, but several triggers are known:Sun exposure-The sun’s UV rays function as the primary factor which causes melasma to develop, and sunlight exposure leads to worsening of melasma symptoms and treatment relapse.
The hormonal shifts which occur during pregnancy and when using birth control pills and hormone replacement therapy, lead to melasma development because they modify body hormone production.People who have family members with melasma, face an increased risk of developing this condition.The skin becomes more sensitive when using particular medications together with certain skincare products. The skin becomes more sensitive when using particular medications, together with certain skincare products.Stress and thyroid problems-Stress and thyroid disorders seem to affect certain individuals who develop these conditions.Melasma is much more common in women, especially those with medium to dark skin tones (Fitzpatrick skin types III–V), but men can also get it.Melasma proves difficult to treat because of its specific characteristicsMelasma is known to be stubborn and often comes back, even after successful treatment. The triggers which include sun exposure and hormonal changes, make it difficult to prevent them from happening. People who try different skin treatments including creams, peels and lasers will experience their dark skin patches return, because they do not protect their skin from sunlight, and their hormone levels continue to shift.The skin becomes irritated during certain treatments which lead to worsening pigmentation symptoms, particularly when patients have darker skin tones, so they should follow a gradual treatment plan under dermatological supervision.Common treatments for melasmaThe treatment of melasma requires patients to use topical creams, while practicing sun protection and undergoing medical procedures depending on their skin condition severity.1. Topical creams (applied on skin)These are the first line of treatment and are used daily:Hydroquinone (HQ) functions as a skin-lightening agent which decreases melanin production during treatment periods that usually last several months.Triple combination cream-The combination of hydroquinone with hydrocortisone steroid and tretinoin retinoid, makes this treatment one of the most effective solutions for melasma.Niacinamide (vitamin B3) serves two purposes by decreasing skin discoloration and strengthening the skin barrier, while being suitable for extended use because it has a mild effect.The treatment of dark spots includes Kojic acid, azelaic acid, arbutin and vitamin C as alternative lightening agents.2. Oral tranexamic acid (oTA)Twinkle Khanna mentioned tranexamic acid, which is a medicine that can be taken by mouth to reduce melasma. Research indicates that oral tranexamic acid serves as a protected supplementary treatment which doctors can use to treat melasma patients, who fail to respond to topical creams. However, it should only be taken under a doctor’s supervision, because it can affect blood clotting in some people.3. Procedures (done by a dermatologist)A dermatologist will recommend treatment options for stubborn melasma cases.The treatment of chemical peels involves applying mild acids such as glycolic acid, salicylic acid and TCA, to remove skin surface layers which helps decrease skin pigmentation.The treatment of laser and light technology includes Q-switched lasers, intense pulsed light (IPL) and fractional lasers, but these methods increase the chances of developing skin irritation and making pigmentation conditions worse, particularly for patients with Indian and South Asian skin types.The treatment of microneedling with microdermabrasion enables skin creams to reach deeper skin layers, while simultaneously enhancing skin texture and reducing pigmentation problems, during the procedure.The most important step: Sun protectionTwinkle Khanna correctly advises people to use sunscreen because sun protection stands as the primary method to control melasma. The sun’s ultraviolet rays activate melasma and lead to its worsening condition, which occurs both under sunny conditions and through window glass and on cloudy days.Experts recommend:People should apply broad-spectrum sunscreen with SPF 30 or higher to their skin throughout each day, regardless of their location inside or outside.They also need to reapply sunscreen every 2–3 hours when they are outside, and when the body starts sweating.They should protect themselves from the sun by using wide-brimmed hats and sunglasses while staying in shaded areas during peak sun hours between 10 a.m. and 4 p.m.The best creams and procedures fail to prevent melasma from returning because they do not provide enough protection against sunlight.Lifestyle and emotional sideTwinkle also shared an important message about self‑care. “Everyone expects us to be Mother India and focus all our energies on the child. Let me tell you — the child will grow up, go to college, and you will still be living with melasma. So give yourself permission to take care of yourself and your skin”. This resonates with many women who feel guilty for spending time and money on their own skin and well‑being,” she said.The treatment of melasma requires more than topical creams and laser therapy because it involves additional aspects.The process requires patients to wait because it needs multiple weeks or months to generate results.Avoiding harsh scrubs and home remedies that can irritate the skin.The management of stress, together with proper sleep practices, will benefit your skin health in general.People should consult dermatologists instead of using powerful skin products which could harm their skin.When to see a dermatologistMelasma is not dangerous, but it’s best to see a dermatologist if:Dark patches appear suddenly or change in shape/colour.The over-the-counter creams have not provided any relief during the past several months.A dermatologist will verify that the condition is melasma while ruling out other pigmentation disorders, and will create a protected treatment approach and track any potential adverse reactions.Disclaimer: This article is informational only and not a substitute for medical advice