Melasma Treatment

Melasma is a chronic skin condition characterised by brown or grey-brown patches — most commonly on the cheeks, forehead, upper lip, and chin. It is caused by overproduction of melanin (skin pigment) by cells called melanocytes, triggered by UV exposure, hormonal changes (pregnancy, oral contraceptives, hormone therapy), heat, and in some cases genetic predisposition. It is significantly more common in women and in people with darker skin tones, including South Asian skin. It is not dangerous, but it can deeply affect confidence.

Melasma is a chronic condition — it can be controlled, faded, and managed extremely well, but it tends to recur with sun exposure or hormonal changes. The goal of treatment is maximum pigmentation clearance combined with long-term maintenance to prevent relapse. Patients who commit to daily SPF 50+ and maintenance protocols achieve and sustain excellent results. Honest management means addressing both active treatment and prevention, not promising a one-time cure.

Effective melasma management uses a layered approach: prescription topical agents (hydroquinone, tretinoin, azelaic acid, tranexamic acid combinations) to suppress melanin production, chemical peels (glycolic, salicylic, or combination) to resurface pigmented skin, laser treatments (Q-switched Nd:YAG, fractional laser) for deeper pigmentation, and oral supplements (tranexamic acid, antioxidants). Treatment intensity is matched to the depth and severity of the pigmentation. Superficial melasma responds well to topicals and peels; deeper dermal melasma requires laser.

Laser treatment for melasma on South Asian skin requires careful selection of laser type, settings, and protocols. Incorrect parameters can paradoxically worsen melasma through post-inflammatory hyperpigmentation. At HOA, our consultant dermatologist uses low-fluence Q-switched Nd:YAG laser protocols specifically calibrated for darker skin types, combined with topical preparation and post-treatment care to maximise safety and efficacy. We never use aggressive ablative settings on melasma-prone skin.

This depends on the depth, extent, and duration of the melasma. Superficial melasma with consistent topical treatment and chemical peels typically shows significant improvement in 8–12 weeks. Deeper or more resistant melasma treated with laser may require 4–8 sessions over 3–6 months. Maintenance treatment is ongoing — monthly or bi-monthly sessions combined with daily SPF sustain results long-term.

Absolutely — UV light is the most powerful trigger for melanin production and melasma recurrence. Even a single day of significant sun exposure can undo weeks of treatment progress. Daily broad-spectrum SPF 50+ is not optional for melasma patients — it is the single most important factor in achieving and maintaining results. Physical sunscreens (zinc oxide, titanium dioxide) offer superior protection for melasma compared to chemical filters.

Yes, though hormonal melasma — often triggered by the contraceptive pill, pregnancy (chloasma), or hormone replacement — can be more persistent. If an ongoing hormonal trigger is present, discussing a change of contraception method with your gynaecologist may significantly improve treatment outcomes. Oral tranexamic acid, prescribed by our dermatologist, has excellent evidence for suppressing hormonally driven melanin production. We work collaboratively and consider the full hormonal picture.

Melasma specifically involves irregular, symmetrical patches triggered by hormones and UV — it is a chronic condition. Post-inflammatory hyperpigmentation (PIH) is darkening that follows skin injury, acne, or inflammation — usually more responsive to treatment and not recurring in the same way. Freckles are genetically determined UV responses. Sun spots (solar lentigines) are discrete dark spots from cumulative UV. Each type requires a slightly different approach, and distinguishing between them accurately is one of the key benefits of consulting a qualified dermatologist.