Is Your Melasma Common or Hormonal? Difference and Treatment

Have you ever wondered whether the blue gray/brown spots on your face are freckles or a clinical condition called melasma? Melasma is a skin disorder that is often misidentified by common people as freckles or hyperpigmentation due to a similar appearance. 

Melasma is a condition where the face, especially the cheeks, nose, and chin area; neck; arms; and back area, is affected. It is actually an inflammatory skin condition that is caused by dysregulation of the immune system, rather than a topical dermatological issue such as hyperpigmentation. The difference between the conditions lies in the type of spots (melasma has spots spread on both sides of the cheek as a mirror image and is common in the face, neck, and arms compared to hyperpigmentation) and the pattern. The condition is often treated as a mere topical condition where skin-lightening serums, stronger acids, or laser treatments are applied without understanding the actual requirements of the condition. Most importantly, there are very few people who are aware of the types of melasma, and as a result, they can hardly intervene with appropriate treatment. 

Melasma can be defined as a chronic, acquired hyperpigmentation disorder that presents as symmetrical brownish macules and patches, most commonly on sun-exposed areas of the face, and disproportionately affects women, particularly during the reproductive years, and individuals with more pigmented phenotypes, specifically Fitzpatrick skin types III through V (Handel et al., 2014; Ribero et al., 2025). Its impact extends beyond appearance; it is a well-documented psychosocial burden (Ghasemiyeh et al., 2024).

Melasma usually has two distinct drivers: chronic UV exposure and hormonal fluctuation. Based on these drivers, the melasma types are identified: one is common melasma caused by UV exposure, and another is hormonal melasma caused by hormonal fluctuations. Additionally, over 40% of melasma patients report having affected relatives, underscoring that inherited susceptibility interacts with both environmental and hormonal drivers (Handel et al., 2014; Ali & Al Niaimi, 2025). Hence, treating these melasma types demands targeted treatment based on the type of melasma. The relapse rate of melasma is high, and the only reason for this is that it does not receive the appropriate type of treatment as per the underlying condition (Ghasemiyeh et al., 2024). 

Common melasma is the most common condition observed among individuals and is closely related to lifestyle and skin care practices. Causes such as cumulative sun exposure, inconsistent sunscreen use, and skin-barrier damage from aggressive treatments (excessive peeling, harsh actives) are directly related to the condition, since compromised skin reacts more to environmental triggers. It is primarily driven by environmental exposure, among which ultraviolet radiation is the major one. Exposure to UVB rays triggers keratinocytes to release melanogenic mediators, including arachidonic acid and alpha-melanocyte-stimulating hormone (α-MSH), which in turn drive melanin production in nearby melanocytes. This pathway has been demonstrated directly in keratinocyte-melanocyte co-culture models exposed to UVB radiation (Ribero et al., 2025). Reactive oxygen species generated by chronic UV exposure further sustain this cycle, contributing to the persistent, treatment-resistant nature of UV-driven pigmentation (Ali & Al Niaimi, 2025). In simple terms, sun exposure causes active production of skin pigment that causes serious damage to the skin, rather than tanning. In melasma-prone skin, this response becomes exaggerated and persistent rather than resolving normally.

Compared to common melasma, hormonal melasma has a completely different mechanism. Unlike any lifestyle-related factors, as observed in common melasma, this is directly linked to hormonal regulation. Estrogen and progesterone regulate melanocyte activity through both genomic signaling, i.e., by acting on gene expression via hormone receptors, and non-genomic signaling, i.e., by faster-acting effects on cell behavior, influencing key enzymes and transcription factors involved in pigment synthesis (Zhang et al., 2025; Ali & Al Niaimi, 2025). Estrogen specifically suppresses melanocyte-stimulating hormone inhibition; hence, when estrogen levels shift, that suppression weakens, and melanin production increases in response.

This mechanism explains why hormonal melasma clusters around specific life events. Epidemiological data show melasma affecting 14.5% to 56% of pregnant women and 11.3% to 46% of oral contraceptive users, with rates varying by population and geography (Zhang et al., 2025). Interestingly, a multinational cohort of 324 women found that only around 20% of cases actually developed during pregnancy itself, while approximately 10% emerged post-menopause, underscoring that hormonal melasma isn't limited to pregnancy alone but reflects any significant shift in estrogen and progesterone activity, including menopause, contraceptive use, and irregular cycles.

The distinguishing features between the two types are:

A patient presenting with symmetrical, well-defined pigmentation alongside menstrual or hormonal symptoms is a very different clinical picture from one whose pigmentation tracks closely with sun exposure and skincare habits, and the two call for different first-line strategies.

The available pharmacologic and procedural options for melasma are extensive, but none are without meaningful limitations, and being honest about this is essential to setting realistic expectations (Gan & Rodrigues, 2024).

• Hydroquinone, long considered the gold-standard topical depigmenting agent, works as a tyrosinase inhibitor but has limitations. Overuse may lead to risks including irritant contact dermatitis and, with prolonged use, exogenous ochronosis, a paradoxical darkening of the skin.
• Tranexamic acid, used both topically and orally, targets the plasmin pathway implicated in melasma's vascular component; its anti-inflammatory and anti-angiogenic properties, alongside its capacity to suppress melanogenesis, have supported its growing use across melasma and several other pigmentary and inflammatory skin conditions, though systemic use carries its own risk profile and requires screening for clotting-related contraindications (Gaćina & Krstanović Ćosić, 2023).
• Chemical peels can accelerate pigment turnover, but risk post-inflammatory hyperpigmentation if performed aggressively or on compromised skin, a particular concern given how often overly aggressive peeling itself contributes to common melasma.
• Laser and light-based procedures can produce visible improvement but carry real risk of rebound hyperpigmentation, particularly in darker skin tones, and typically require maintenance sessions to sustain results.

The literature studies suggest that the options for treatment are limited by insufficient long-term clinical effectiveness, high relapse rates, and a meaningful burden of adverse effects, indicating a need for precise management, emphasizing a combination of approaches and realistic, sustained maintenance (Ghasemiyeh et al., 2024; Gan & Rodrigues, 2024). A Latin American expert consensus on melasma treatment similarly emphasizes combination therapy and long-term maintenance planning, reinforcing that this isn't a regional or isolated finding but a broadly shared clinical conclusion (Ocampo-Candiani et al., 2025).

Studying the relevance of aromatherapy in this context would require assessing whether aromatherapy can interact with the rate-limiting enzyme tyrosinase to affect melanin production. This shows the growing recognition of clinical aromatherapy as a legitimate evidence-based practice in dermatologic and general healthcare settings (Farrar & Farrar, 2020).

Considering the activity of essential oils in the immune system, some of the observations are given below:

• Eucalyptus globulus essential oil has been shown to act as a reversible, non-competitive tyrosinase inhibitor, achieving a 59.6% inhibition rate at a 10 mg/mL concentration in controlled testing. Circular dichroism analysis showed the oil induces conformational changes in the tyrosinase enzyme itself, disrupting its catalytic function by binding 1,8-cineole, the primary compound of this essential oil. The same research demonstrated a significant reduction in intracellular melanin content in melanoma cell models following treatment (Zhu & Zhong, 2025).
• Daisy flower (Bellis perennis) extract has also been shown in controlled testing to inhibit tyrosinase activity in a dose-dependent manner (Karić et al., 2023). The extract follows a similar mechanism to that of eucalyptus oil, indicating a genuine enzyme-level interaction of the essential oil.
• Other than these essential oils, there are chemical compounds such as kojic acid, niacinamide, and other extracts that work through the same mechanism to prevent melanin production and clear the spots.

This supports aromatherapy as a genuinely plausible adjunct with a real mechanism, not yet as a replacement for established first-line treatment.

For common melasma, the priority is interrupting the UV-triggered mediator cascade, and thus consistent use of high-SPF sun protection is of utmost importance, along with certain active ingredients that can do gentle exfoliation and target tyrosinase activity to support barrier protection along with skin lightening. Keya Seth’s Skin Lightening Face Serum, combining Daisy Flower, Alpha Arbutin, and Mulberry Root with Hyaluronic Acid, works well in these conditions due to its enzyme-level brightening action. Alpha Arbutin and a mulberry root extract work through competitive tyrosinase inhibition for skin brightening, and hyaluronic acid supports the skin barrier with hydration.

For hormonal melasma, again, sun protection remains essential, but it does not affect the root cause of the hormonal fluctuations, instead works topically. Keya Seth’s Skin Lightening Spot Serum, formulated with the same Daisy Flower, Alpha Arbutin, and Mulberry Root complex alongside Sodium Ascorbyl Phosphate, could target spot-specific pigmentation, relevant to hormonal melasma. Sodium Ascorbyl Phosphate contributes antioxidant action that helps counter the oxidative stress component of melanogenesis, complementing the tyrosinase-inhibiting actives rather than duplicating their mechanism. Additionally, aromatherapy plays a role in reducing stress that interferes with estrogen and hormonal balance, favoring melasma control.

Melasma is a relapse-prone condition that often gets misdiagnosed as hyperpigmentation, or even if identified, it lacks the clarity of whether it's a common melasma or a hormonal one. Common melasma responds to interrupting the UV-driven pigment cascade; however, hormonal melasma responds better when the underlying hormonal driver is acknowledged. Aromatherapy has an enzyme-level role in tyrosinase inhibition, as well as interfering with the stress pathway to control the hormonal levels, revealing a strong option to treat both types of melasma from the root. 

Ali, L., & Al Niaimi, F. (2025). Pathogenesis of melasma explained. International Journal of Dermatology, 64(7), 1201–1212. https://doi.org/10.1111/ijd.17718 (Paywalled — Wiley)

Farrar, A. J., & Farrar, F. C. (2020). Clinical aromatherapy. Nursing Clinics of North America, 55(4), 489–504. https://doi.org/10.1016/j.cnur.2020.06.015 (Paywalled — Elsevier)

Gaćina, K., & Krstanović Ćosić, A. (2023). The use of tranexamic acid in dermatology. Acta Clinica Croatica, 62(2), 368–372. https://doi.org/10.20471/acc.2023.62.02.16

Gan, C., & Rodrigues, M. (2024). An update on new and existing treatments for the management of melasma. American Journal of Clinical Dermatology, 25(5), 717–733. https://doi.org/10.1007/s40257-024-00863-2

Ghasemiyeh, P., Fazlinejad, R., Kiafar, M. R., Rasekh, S., Mokhtarzadegan, M., & Mohammadi-Samani, S. (2024). Different therapeutic approaches in melasma: Advances and limitations. Frontiers in Pharmacology, 15, 1337282. https://doi.org/10.3389/fphar.2024.1337282

Handel, A. C., Miot, L. D., & Miot, H. A. (2014). Melasma: A clinical and epidemiological review. Anais Brasileiros de Dermatologia, 89(5), 771–782. https://doi.org/10.1590/abd1806-4841.20143063

Karić, N., et al. (2023). Tyrosinase inhibition, antioxidant and antibacterial activity of commercial daisy extract (Bellis perennis). Journal of Pharmaceutical Research International, 35(5), 13–19. Article no. JPRI.98097.

Ocampo-Candiani, J., Alas-Carbajal, R., Bonifaz-Araujo, J. F., Marín-Castro, H., Valenzuela-Ahumada, F., Véliz-Barandiarán, J. L., Vila Echague, A., Zepeda-Reyes, D. E., & Miot, H. A. (2025). Latin American consensus on the treatment of melasma. International Journal of Dermatology, 64(3), 499–512. https://doi.org/10.1111/ijd.17522 (Paywalled — Wiley)

Ribero, S., Romani, A., Mattozzi, C., & Minoretti, P. (2025). Comparative efficacy of skin-lightening formulations in suppressing ultraviolet B (UVB)-induced arachidonic acid, alpha-melanocyte-stimulating hormone (α-MSH), and melanin expression: An in vitro keratinocyte-melanocyte co-culture study. Cureus, 17(2), e78908. https://doi.org/10.7759/cureus.78908

Zhang, J., Wang, T., Li, Z., Qin, C., Dai, J., Zhao, Y., Wu, S., & Jia, Z. (2025). Hormonal crosstalk in melasma: Unraveling the dual roles of estrogen and progesterone in melanogenesis. International Journal of Molecular Sciences, 26(22), 10856. https://doi.org/10.3390/ijms262210856

Zhu, H., & Zhong, X. (2025). Inhibition effects of Eucalyptus globulus Labill. essential oil against tyrosinase. Scientific Reports, 15(1), 16212. https://doi.org/10.1038/s41598-025-00047-w