Melasma Is Managed, Not Cured: What Actually Keeps It Quiet
Melasma is the brown, symmetrical patching that appears on the cheeks, forehead and upper lip, often after a summer, a pregnancy or a change in hormones. It is one of the most frequent reasons people ask for help with pigment, and one of the easiest to make worse. The honest summary is that it can be improved a great deal, that it tends to return, and that the treatments that work best are the gentlest ones.
Melasma is the brown, even patching that shows up on the cheeks, forehead and upper lip, often after a summer, a pregnancy or a change in hormones. It is one of the most common reasons people ask for help with skin colour, and one of the easiest conditions to make worse. The honest summary is that it can be improved a great deal, that it tends to come back, and that the treatments that work best are the gentle ones.
Melasma: the essentials
The short version
A chronic acquired pigment disorder with symmetrical brown or grey-brown patches, mostly on the face
A long-lasting skin colour condition with even, matching brown or grey-brown patches, mostly on the face.
Ultraviolet and visible light, hormones, inflammation or irritation, some medicines, and family tendency
Sun and daylight, hormones, irritation of the skin, some medicines, and a family tendency.
Visible light alone can keep melasma active, and clear sunscreens block ultraviolet but little visible light
Ordinary daylight alone can keep melasma going, and clear sunscreens block the sun’s burning rays but very little of it.
A tinted sunscreen containing iron oxides, a wide-brimmed hat, shade and protective clothing
A tinted sunscreen with iron oxides in it, a wide-brimmed hat, shade and covering clothing.
Layered and conservative: protection, prescription topical care, light peels, and carefully chosen laser where appropriate
Layered and gentle: protection, prescription creams, light peels, and a carefully chosen laser where it suits.
Often improved a great deal, but prone to relapse, so maintenance is part of the plan
It can often be improved a lot, but it tends to come back, so keeping it quiet is part of the plan.
More than a pigment problem
More than a colour problem
Melasma looks like a surface stain, and for a long time it was treated as one. It is better understood as a condition of the skin’s whole environment. The pigment cells are overactive, but research also shows changes in the deeper skin beneath them, including more small blood vessels and sun-damaged tissue, which is one reason the colour is so persistent and so prone to return.
Melasma looks like a stain on the surface, and for a long time it was treated like one. It is better understood as a condition of the whole skin. The cells that make colour are overactive, but studies also show changes in the deeper skin underneath, including extra tiny blood vessels and sun-damaged tissue. That is one reason the colour is so stubborn and so likely to return.
It is common, it mostly affects women, and it appears more often in people with medium to darker skin tones, though it can occur in anyone. It can also run in families, so it is not unusual for a mother, sister or aunt to have the same pattern. The cheeks, forehead, upper lip and chin are the usual places, and it can also appear on the chest and forearms.
It is common, it affects women far more than men, and it appears more often in people with medium to darker skin, although anyone can get it. It can run in families, so it is not unusual for a mother, a sister or an aunt to have the same pattern. The cheeks, forehead, upper lip and chin are the usual places, and it can also show up on the chest and forearms.
Diagnosis matters before anything else, because several different things look alike. Sun spots, pigment left behind by acne or a rash, and melasma behave differently, and a treatment that helps one can worsen another. A new or changing dark spot is a separate question and is examined on its own. The first step here is an examination, sometimes with dermoscopy or a Wood lamp, and not a product.
Getting the diagnosis right comes before anything else, because several things look alike. Sun spots, dark marks left behind by acne or a rash, and melasma all behave differently, and a treatment that helps one can make another worse. A new or changing dark spot is a separate question and is checked on its own. The first step here is an examination, sometimes with a magnifying scope or a special lamp, and not a product.
Why light is the lever
Why light is the thing to control
Of everything that triggers melasma, light is the one most within reach. Ultraviolet light darkens it, and so does visible light, the ordinary daylight that a conventional sunscreen does little to block. In practice that means a person can be diligent with sunscreen every morning and still have melasma that will not settle, because the part of the spectrum driving it is going through the lotion.
Of everything that sets melasma off, light is the one you can most easily control. Ultraviolet light darkens it, and so does visible light, the ordinary daylight that a normal sunscreen does little to block. So someone can put on sunscreen faithfully every morning and still have melasma that will not settle, because the part of the light driving it is passing straight through.
This is why tinted products containing iron oxides are preferred, since iron oxides block visible light as well as ultraviolet. A wide-brimmed hat and clothing with a UPF rating do work that a cream cannot, because they do not wear off, are not applied too thinly and do not need reapplying. Shade, and avoiding the middle of the day outdoors, add to it. It is the cheapest and most reliable part of the whole plan, and the part patients most often skip.
This is why tinted sunscreens containing iron oxides are preferred, because iron oxides block visible light as well as the burning rays. A wide-brimmed hat and clothing with a sun-protection rating do a job that cream cannot, because they do not wear off, are not put on too thinly and do not need topping up. Shade, and keeping out of the midday sun, add to it. It is the cheapest and most reliable part of the whole plan, and the part people most often skip.
Heat appears to matter as well, and many people notice flares in hot weather. Hormones are the other major lever, which is why pregnancy, hormonal contraception and hormone therapy can bring melasma on or deepen it. These are not always things that can or should change, and part of the work is deciding what can sensibly be adjusted.
Heat seems to matter as well, and many people notice flares in hot weather. Hormones are the other big lever, which is why pregnancy, hormonal contraception and hormone therapy can bring melasma on or make it darker. These are not always things that can or should change, and part of the work is deciding what can sensibly be adjusted.
Why it comes back
Why it comes back
Melasma is chronic and relapse-prone by nature, not because treatment failed. The cells and tissue that produce it stay primed, so when light, heat, hormones or irritation return, the pigment returns with them. This is why it is described as managed rather than cured, and why a clear result at three months is a point on a curve and not the end of it.
Melasma is long-lasting and likely to relapse by its nature, not because treatment failed. The cells and the tissue around them stay primed, so when light, heat, hormones or irritation return, the colour returns too. That is why it is described as managed rather than cured, and why a clear result at three months is a point along the way and not the finish line.
The least intuitive part is that irritation itself is a trigger. Inflammation in the skin signals the pigment cells to produce more, which means that an aggressive peel, an abrasive scrub or a laser used at the wrong energy can leave melasma darker than before. In this condition more is very often worse, and the people who do best are usually the ones treated with patience and restraint.
The least obvious part is that irritation is itself a trigger. When the skin is inflamed, it tells the colour cells to make more, so a harsh peel, a rough scrub or a laser used at the wrong strength can leave melasma darker than before. With this condition more is very often worse, and the people who do best are usually treated with patience and a light touch.
It also explains why resurfacing lasers such as erbium and CO2 are not a first-line treatment for melasma. They are valuable for the sun damage, roughness and fine lines that often share the same face, but the heat and inflammation they involve can provoke the melasma, so it continues to be managed alongside with protection and topical care.
It also explains why resurfacing lasers such as erbium and CO2 are not the first choice for melasma. They are valuable for the sun damage, roughness and fine lines that often share the same face, but the heat and inflammation they cause can provoke the melasma, so it is still managed alongside them with protection and creams.
What treatment actually looks like
What treatment really looks like
Treatment is layered, not a single procedure. Daily photoprotection is the foundation. Prescription topical therapy reduces pigment production or speeds its turnover, chosen for the skin’s sensitivity and for pregnancy status where relevant. Medical-grade skin care maintains the result between active treatments, and light chemical peels, kept deliberately conservative, can help pigment sitting near the surface.
Treatment comes in layers, not as one procedure. Daily protection from light is the base. Prescription creams reduce how much colour the skin makes or help it clear faster, chosen to suit how sensitive your skin is and whether you are pregnant. Medical-grade skin care keeps the result steady between treatments, and light chemical peels, kept gentle on purpose, can help colour sitting near the surface.
Where a laser has a place, the choice is made for the diagnosis and the skin tone. A picosecond laser delivers energy in extremely short pulses that break pigment up largely by a photomechanical effect rather than by heating the surrounding skin, which matters because heat provokes inflammation. The 1064 nm wavelength is absorbed less by the melanin in the upper skin, which is why it is chosen for medium and darker skin tones. Fraxel FTX, at its superficial 1927 nm setting, is used selectively for pigment. In this practice Dr. Gallacher performs every laser treatment herself, because the endpoint is a judgement made during treatment.
Where a laser has a place, it is chosen for the diagnosis and for your skin tone. A picosecond laser gives out energy in extremely short bursts that break colour up mainly by a shaking effect, not by heating the skin around it, which matters because heat provokes inflammation. The 1064 nm setting is absorbed less by the colour in the top layer of skin, which is why it is chosen for medium and darker skin tones. Fraxel FTX, on its gentle surface setting, is used selectively for colour. At this practice Dr. Gallacher performs every laser treatment herself, because knowing when to stop is a judgement made during the treatment.
Expect months, not weeks. Discrete sun-induced spots can clear in one to three sessions, but melasma usually needs a combination of measures over several months, followed by maintenance. Individual results vary, no outcome can be guaranteed, and the plan is adjusted to how the skin responds. The wider logic of matching a device to a target is in Why One Laser Cannot Do Everything.
Expect months, not weeks. Single sun spots can clear in one to three visits, but melasma usually needs a mix of measures over several months, followed by upkeep. Results vary from person to person, no outcome can be guaranteed, and the plan changes as your skin responds. The bigger idea of matching a laser to its target is in Why One Laser Cannot Do Everything.
A sensible rhythm through the year
A sensible rhythm through the year
Melasma has a seasonal pattern, darkening through the summer and easing a little in winter, and the plan can follow it. Autumn is a good time to start or restart, because the skin is out of peak exposure, any tan has faded and there are months of lower light ahead in which to build the foundation. By the following summer the protection habits are established and the skin is in its best position to hold.
Melasma follows the seasons, darkening through the summer and easing a little in winter, and your plan can follow them too. Autumn is a good time to start or restart, because your skin is past the peak of sun, any tan has faded, and there are months of lower light ahead in which to build the base. By next summer the protection habits are in place and your skin is in the best position to hold.
The routine that keeps melasma quiet is unglamorous: the tinted sunscreen every morning, the hat, the gentle skin care and the maintenance visits agreed in advance. It is the consistency, not the intensity, that makes the difference, and it is worth saying plainly that people who find a rhythm they can keep up usually do better than people who chase a stronger treatment each time the colour stirs.
The routine that keeps melasma quiet is dull: the tinted sunscreen every morning, the hat, gentle skin care and upkeep visits agreed in advance. It is steadiness, not strength, that makes the difference. People who find a rhythm they can keep up usually do better than people who chase a stronger treatment each time the colour stirs.
Questions patients ask
Is melasma the same as sun spots?
Is melasma the same as sun spots?
No. Sun spots, or lentigines, are discrete patches caused by accumulated sun exposure and often clear well with a laser. Melasma is a distinct pattern of acquired pigment, usually symmetrical, that is influenced by hormones and light and tends to relapse. They can occur together, which is why the diagnosis comes before the treatment.
No. Sun spots are separate, well-defined patches caused by years of sun, and they often clear well with a laser. Melasma is a different pattern of colour, usually even on both sides of the face, influenced by hormones and light, and likely to come back. The two can occur together, which is why the diagnosis comes before the treatment.
Can a laser cure melasma?
Can a laser cure melasma?
A laser can help, but it cannot cure a condition that is biologically prone to recur. It is used selectively and gently, as one part of a plan that rests on light protection and topical care. Used too aggressively, a laser can make melasma worse, so the settings and the skin tone matter.
A laser can help, but it cannot cure a condition that is built to come back. It is used gently and selectively, as one part of a plan that rests on protection from light and creams. Used too strongly, a laser can make melasma worse, so the settings and your skin tone matter.
Will melasma that began in pregnancy fade?
Will melasma that started in pregnancy fade?
In some people it fades after delivery or after a hormonal trigger is stopped, but in many it persists or returns, particularly with sun exposure. Pregnancy also changes which topical medicines and procedures are appropriate, so treatment during pregnancy is limited and individual.
In some people it fades after the baby is born or after a hormone trigger is stopped, but in many it stays or comes back, especially with sun. Pregnancy also changes which creams and treatments are suitable, so what can be done during pregnancy is limited and depends on the person.
Why did mine get darker after a peel or laser?
Why did mine get darker after a peel or laser?
Irritation and heat are triggers. If a treatment inflames the skin more than it can tolerate, the pigment cells respond by making more, and the melasma can deepen. It is the reason treatment in this condition is kept conservative, and why sun protection during healing is essential.
Irritation and heat set melasma off. If a treatment inflames your skin more than it can cope with, the colour cells respond by making more, and the melasma can get darker. That is why treatment for it is kept gentle, and why protecting your skin from the sun while it heals is so important.
Does it matter if I mostly stay indoors?
Does it matter if I mostly stay indoors?
Yes, a little. Daylight through a window carries visible light and UVA, and for someone with melasma that can be enough to keep it active over months. Sitting away from bright windows and wearing a tinted sunscreen on the face during the day is a modest precaution that makes a difference.
Yes, a little. Daylight through a window carries visible light and UVA, and for someone with melasma that can be enough to keep it going over months. Sitting away from bright windows and wearing a tinted sunscreen on your face in the daytime is a small step that makes a difference.
- Handel AC, Miot LDB, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-782. Source
Where to go next
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
