Summary
- Melasma is a common pigmentation condition that causes patchy brown or grey-brown discolouration, typically appearing symmetrically on both sides of the face, particularly on the cheeks, forehead, upper lip and nose.
- Melasma can be triggered or worsened by sun exposure, visible light, hormonal changes, heat, inflammation and genetic factors.
- Treatment focuses on reducing pigmentation while minimising irritation and preventing recurrence. Options include sun and visible-light protection, topical treatments, selected oral medication, chemical peels and carefully selected laser or energy-based treatments.
- Because melasma can worsen following inflammation or overly aggressive treatment, treatment plans should be conservative and personalised to your skin type and pigmentation.
- Improvement is usually gradual and maintenance treatment is often required. Although melasma cannot always be permanently cured, consistent treatment and long-term management can help maintain clearer, more even-looking skin.
Causes, Treatment Options and Long-Term Management of Facial Pigmentation
Melasma is a common pigmentation condition that causes irregular brown or grey-brown patches on the face. The pigmentation often appears symmetrically on both sides of the face, commonly affecting the cheeks, forehead, nose and upper lip. It occurs more frequently in women and in people with Asian and darker skin types.
Although melasma is harmless, it can be persistent and has a tendency to recur.
At Stephanie Ho Dermatology, we take a personalised approach to melasma treatment, using a combination of topical treatments, selected oral medication and carefully chosen procedures according to your skin type, severity of pigmentation and individual triggers.
What Is Melasma?
Melasma most commonly affects the:
- cheeks
- forehead
- upper lip
- nose
- chin
The pigmentation often appears symmetrically on both sides of the face. Less commonly, melasma may also occur on other sun-exposed areas such as the neck and forearms.
Melasma is more complex than simply having excess pigment. In addition to increased melanin production, changes in blood vessels, inflammation and sun-related damage to the deeper supporting structures of the skin, including collagen and elastic tissue, may contribute to the condition.
Pigmentation may also occur at different depths within the skin. These multiple factors help explain why melasma can be difficult to treat and why it often returns.
For some patients, treatment may therefore include approaches that not only target excess pigmentation but also promote skin and collagen remodelling.
What Causes Melasma?
Melasma does not usually have a single cause. Several factors can trigger or worsen it:
- Sun exposure – ultraviolet radiation stimulates pigment-producing cells and is one of the most important triggers for melasma.
- Visible light – visible light can contribute to pigmentation, particularly in darker skin types.
- Hormonal changes – pregnancy, oral contraceptives and other hormonal treatments may trigger or worsen melasma.
- Genetics – people with a family history of melasma are more likely to develop it.
- Heat – heat exposure may contribute to melasma and can worsen pigmentation in some patients.
- Inflammation and skin irritation – irritation from skincare products, procedures or overly aggressive treatment can stimulate further pigmentation.
Melasma is therefore best regarded as a chronic, relapsing pigmentation condition rather than a problem that can always be permanently removed.
How Is Melasma Treated?
Successful melasma treatment usually requires a combination of approaches.
Treatment should be gradual and carefully tailored. Excessive irritation, inflammation or overly aggressive procedures can cause post-inflammatory hyperpigmentation or make existing melasma worse.
1. Sun and Visible-Light Protection
Daily photoprotection is one of the most important parts of treating melasma and preventing it from worsening or recurring.
We recommend:
- choosing a broad-spectrum SPF 50+ sunscreen that protects against UVA, UVB and visible light, such as a tinted sunscreen containing iron oxides
- applying sunscreen adequately and reapplying when outdoors
- using additional protection such as hats, umbrellas and shade where appropriate
- reducing prolonged direct sun exposure
Heat can also aggravate melasma in some people, so reducing prolonged or intense heat exposure may be helpful.
2. Topical Treatments
Topical treatment forms the foundation of melasma management.
Depending on your skin type, pigmentation and tolerance, treatments may include:
- hydroquinone
- tretinoin or other retinoids
- azelaic acid
- kojic acid
- cysteamine
- topical tranexamic acid
- combination prescription creams
These treatments work through different pathways to reduce pigment production, increase pigment clearance and improve skin turnover.
Treatment needs to be adjusted if excessive redness, dryness or irritation develops, as inflammation itself can worsen pigmentation.
3. Oral Tranexamic Acid
Oral tranexamic acid can be an effective treatment for melasma and may be used together with topical treatments as part of a combination treatment plan.
Studies have shown improvement in the majority of patients treated with oral tranexamic acid. In a large Singapore study involving more than 500 patients with melasma, almost 90% showed improvement, with many patients responding within the first two months of treatment.
Oral tranexamic acid works on several pathways involved in melasma to help reduce pigment production and inflammation.
It is not suitable for everyone. Before prescribing oral tranexamic acid, your dermatologist will review your medical history and assess for contraindications, particularly risk factors for blood clots.
When appropriate, oral tranexamic acid can be started alongside topical treatment and other carefully selected melasma treatments under medical supervision.
4. Laser and Energy-Based Treatments
Laser and energy-based treatments can form part of a combination treatment approach for melasma and may be used alongside topical and oral treatments when appropriate.
Melasma needs to be treated differently from many other forms of pigmentation. Excessive heat, inflammation or aggressive treatment may trigger post-inflammatory hyperpigmentation or cause melasma to worsen. Treatment type, settings and intervals therefore need to be carefully selected.
Gentle Pigment Lasers
Selected pigment lasers, including picosecond lasers, may be used at conservative settings to gradually improve pigmentation.
The type of laser and treatment settings are selected according to your skin type, pigmentation and response to treatment. Aggressive or repeated high-energy treatment is avoided because it can increase the risk of rebound pigmentation and other pigmentary changes.
Radiofrequency Microneedling
Radiofrequency microneedling can be incorporated into a combination treatment programme for melasma, including from the start of treatment when appropriate.
It delivers controlled radiofrequency energy into the skin through fine needles, promoting dermal and collagen remodelling. This may help address some of the changes associated with melasma while also improving overall skin texture and quality.
Treatment settings are carefully selected to minimise unnecessary heat and inflammation, particularly in Asian and darker skin types.
5. Chemical Peels
Superficial chemical peels can also be incorporated into a combination treatment programme for melasma.
Options may include mild peels such as:
- mandelic acid
- glycolic acid
- pyruvic acid
- other superficial peeling agents
Chemical peels increase skin turnover and can help improve superficial pigmentation. The type and strength of peel need to be selected carefully, particularly in Asian and darker skin types, because excessive irritation can cause post-inflammatory hyperpigmentation.
Melasma Treatment Options at a Glance
| Treatment | Main Role | Important Considerations |
|---|---|---|
| Sun and visible-light protection | Reduces stimulation of further pigmentation and helps maintain results | Choose a broad-spectrum SPF 50+ sunscreen that protects against UVA, UVB and visible light, such as a tinted sunscreen containing iron oxides |
| Topical treatments | Reduce pigment production and increase pigment clearance | Often form part of combination treatment; excessive irritation should be avoided |
| Oral tranexamic acid | Can be very effective in reducing melasma pigmentation | Can be used alongside other treatments when appropriate; requires medical assessment before treatment |
| Gentle pigment lasers | Gradually target excess pigmentation | Can be combined with other treatments; conservative settings are important to minimise the risk of worsening pigmentation |
| Radiofrequency microneedling | Promotes dermal and collagen remodelling and may improve skin quality | Can be incorporated into combination treatment, including from the start when appropriate |
| Superficial chemical peels | Increase skin turnover and improve superficial pigmentation | Can complement other treatments; peel strength should be carefully selected to minimise irritation |
What Results Can You Expect?
Melasma usually improves gradually rather than disappearing after a single treatment.
Depending on the severity of your pigmentation and the treatments selected, you may notice:
- lighter pigmentation
- more even-looking skin tone
- improved skin clarity
- reduced contrast between areas of melasma and surrounding skin
Improvement generally develops over several weeks to months.
Results vary between individuals, and melasma can recur following sun exposure, visible light, heat, hormonal changes or other triggers.
Maintenance treatment is therefore often an important part of long-term management.
Long-Term Management of Melasma
Melasma is usually managed rather than permanently cured.
Long-term control may involve:
- consistent daily sun and visible-light protection
- maintenance topical treatment
- reducing excessive sun and heat exposure
- avoiding unnecessary skin irritation
- avoiding overly aggressive pigmentation treatments
- periodic review and adjustment of treatment
Once pigmentation has improved, treatment can often be simplified to a maintenance programme designed to reduce the likelihood of recurrence.
Why Specialist Care Matters
Melasma can be challenging to treat because treatment itself can sometimes aggravate the condition. Getting the diagnosis right is therefore an important first step.
Melasma can sometimes look similar to other causes of facial pigmentation, such as sun spots and post-inflammatory hyperpigmentation, and it is also possible to have more than one type of pigmentation at the same time. As these conditions may require different treatment approaches, an incorrect diagnosis may lead to treatment that is ineffective or may even make the pigmentation worse.
Dermatologists are trained to diagnose and manage the different causes of facial pigmentation. At Stephanie Ho Dermatology, we assess your pigmentation pattern, skin type, medical history, possible triggers and previous treatments before developing an individualised treatment plan.
Our approach emphasises gradual, sustained improvement while minimising unnecessary irritation and the risk of treatment-related pigmentation.
Frequently Asked Questions
Can Melasma Be Permanently Cured?
Melasma is a chronic pigmentation condition that has a tendency to recur. Although it cannot always be permanently cured, treatment can significantly improve pigmentation and help achieve a clearer, more even skin tone.
Recurrence may occur following sun and visible-light exposure, hormonal changes, heat or other triggers. Consistent photoprotection and maintenance treatment can help maintain improvement and reduce the likelihood of melasma returning.
Are Lasers Safe for Melasma?
Yes, lasers can be safely used to treat melasma when the appropriate laser and treatment settings are carefully selected.
Melasma needs to be treated differently from many other forms of pigmentation. Gentle pigment lasers can gradually improve pigmentation, whereas overly aggressive treatment may trigger inflammation, post-inflammatory hyperpigmentation or worsening of melasma.
Your dermatologist will assess your skin type and pigmentation before selecting the most appropriate laser and treatment settings.
How Long Does Melasma Treatment Take?
Melasma usually improves gradually over several weeks to months, although some patients may notice improvement earlier.
The rate of improvement varies according to the severity and depth of pigmentation, your skin type, individual triggers, the treatments used and your response to treatment.
Once the pigmentation has improved, maintenance treatment is often recommended to help preserve the results.
What Causes Melasma to Flare?
Common triggers include:
- sun exposure
- visible light
- hormonal changes, including pregnancy and hormonal medications
- heat
- skin irritation and inflammation
Triggers vary between individuals. Identifying and reducing your own triggers, together with consistent photoprotection and appropriate treatment, can help keep melasma under control.
How Do I Know if My Pigmentation Is Melasma or Sun Spots?
Melasma and sun spots are different types of pigmentation but can sometimes look similar.
Melasma typically appears as irregular, often symmetrical patches of pigmentation, commonly affecting the cheeks, forehead, nose and upper lip. Sun spots tend to appear as individual, more clearly defined brown spots on areas that have accumulated significant sun exposure over time.
It is also common to have more than one type of pigmentation at the same time.
As different pigmentation conditions respond to different treatments, getting the diagnosis right is important. A dermatologist can distinguish melasma from sun spots, post-inflammatory hyperpigmentation and other causes of facial pigmentation before recommending appropriate treatment.
How Can I Prevent Melasma From Getting Worse?
Daily photoprotection is one of the most important ways to prevent melasma from worsening or recurring.
Choose a broad-spectrum SPF 50+ sunscreen that protects against UVA, UVB and visible light, such as a tinted sunscreen containing iron oxides. Hats, umbrellas and shade provide useful additional protection when outdoors.
Reducing excessive sun and prolonged heat exposure may also help. Avoid unnecessary skin irritation and overly aggressive pigmentation treatments, as inflammation can worsen melasma.
Does Melasma Go Away Naturally?
Melasma may fade in some people, particularly when a hormonal trigger such as pregnancy resolves. However, it can also persist for many years or recur after initially improving.
Treatment can significantly reduce pigmentation, while ongoing photoprotection and maintenance treatment can help maintain improvement.
Can Melasma Be Treated During Pregnancy?
Yes. Melasma can be managed during pregnancy, although the range of suitable treatments is more limited.
Sun and visible-light protection are particularly important. Pregnancy-appropriate topical treatments, such as azelaic acid, may be considered. Selected gentle superficial chemical peels may also be used during pregnancy.
Hydroquinone, topical retinoids and oral tranexamic acid are generally avoided during pregnancy. Laser and energy-based procedures are also usually deferred until after pregnancy.
Your dermatologist can recommend an appropriate treatment and skincare programme during pregnancy.
Book a Consultation
If you are concerned about melasma or persistent facial pigmentation, obtaining the correct diagnosis is an important first step.
At Stephanie Ho Dermatology, we assess your pigmentation pattern, skin type, possible triggers and previous treatments before developing an individualised treatment plan.
Contact us to arrange a consultation.