Melasma is a common yet complex skin condition that can have a significant emotional impact on those who experience it. Although it does not pose a serious medical threat, the visible pigmentation it causes can be distressing and often affects self-confidence. Many people hope for a quick solution—such as a laser treatment—that will permanently remove the pigmentation. In reality, melasma is a chronic condition that can usually be controlled, but rarely completely cured.
What Does Melasma Look Like?
Melasma typically appears as patches of brown or grey-brown pigmentation on the skin. These patches are often symmetrical and most commonly occur on sun-exposed areas of the face, including:
• The forehead
• The cheeks (malar areas)
• The bridge of the nose
• Above the upper lip
Although it can develop on other parts of the body, this is less common. The pigmentation itself can occur in different layers of the skin:
• Epidermal melasma – pigment located in the outer layer of the skin and generally easier to treat.
• Dermal melasma – pigment located deeper in the skin and more resistant to treatment.
• Mixed melasma – a combination of both.
Melasma is particularly common in individuals with darker skin tones (higher Fitzpatrick skin types).
What Causes Melasma?
Melasma does not have a single cause. Instead, it develops through a combination of genetic, environmental, and hormonal influences.
Genetics play a strong role. Many people with melasma report that other family members have experienced similar pigmentation patterns.
Sun exposure and heat are among the most powerful triggers. Ultraviolet radiation stimulates pigment-producing cells (melanocytes), while heat can worsen inflammation and vascular activity within the skin—both of which contribute to pigment production.
Hormonal changes are another key factor. Melasma frequently appears or worsens during pregnancy, which is why it is sometimes referred to as the “mask of pregnancy.” Hormonal contraceptives can also trigger or exacerbate the condition in some individuals.
Other contributing factors may include:
• Certain medications that increase photosensitivity
• Dietary triggers in some people
• Skin barrier dysfunction and inflammation
Emerging research suggests that melasma involves more than just excess pigment. Studies have shown alterations in gene expression related to pigment production, as well as increased blood vessel activity and inflammation in the skin. The skin barrier itself may also be weaker, with thinner epithelium and altered lipid composition.
Although melasma predominantly affects women, men can develop it as well. However, men account for only about 10% of cases, while women represent roughly 90%.
Managing Melasma: A Long-Term Approach
Because melasma is chronic and influenced by multiple triggers, successful management usually requires a combination of treatments and lifestyle adjustments.
1. Sun and Heat Protection
Sun protection is the foundation of melasma management. This includes:
• Daily broad-spectrum sunscreen
• Wearing hats and protective clothing
• Avoiding excessive heat exposure where possible
Heat itself—not just UV light—can aggravate melasma, so minimizing prolonged exposure to hot environments may help reduce flare-ups.
2. Identifying Personal Triggers
Some individuals notice worsening pigmentation after certain foods, medications, or hormonal changes. Identifying and reducing these triggers can sometimes help limit progression.
For those considering hormonal contraceptives, discussing the potential risk of melasma with a healthcare provider may be worthwhile.
Pregnancy-related melasma cannot always be prevented, but understanding that it may occur can help individuals prepare and seek early management.
Medical Treatments
Melasma is best approached as a medical skin condition, often requiring professional care.
Treatment may include:
• Topical antipigment medications that suppress melanin production
• Oral medications in selected patients to regulate pigment pathways
• Carefully selected chemical peels
Treatment plans are usually tailored to each individual, as skin sensitivity and treatment response vary significantly.
Energy-Based Treatments
Laser and light-based therapies can sometimes help—but they must be used cautiously.
Low-energy laser or IPL treatments may assist by targeting pigment and reducing abnormal vascular activity in the skin. In some cases, combining different gentle laser approaches can help stabilise the skin environment.
However, aggressive treatments can worsen melasma. Devices that generate significant heat—such as radiofrequency microneedling or high-intensity focused ultrasound (HIFU)—may stimulate further pigment production and are often avoided in patients with melasma.
Microneedling remains somewhat controversial. Superficial needling that does not penetrate the basement membrane may help repair the skin barrier and reduce inflammation, but deeper needling can potentially push pigment further into the skin.
The Importance of Expertise
Melasma management is rarely straightforward. Some patients respond well to treatment, while others remain resistant despite multiple approaches.
For this reason, practitioner experience and careful treatment planning are crucial. Understanding the underlying biology of melasma, and recognising when certain treatments may do more harm than good, is essential for achieving the best possible outcome.
With the right approach, most individuals can significantly improve the appearance of melasma and maintain long-term control, even if complete eradication is not possible.
Ready to address your pigmentation with Shape Clinic?
Thorough clinical assessment is essential for managing complex concerns like melasma. Our team focuses on safe, evidence-based practices to help you achieve your aesthetic goals.
We may consider any of the following treatments:
- Address underlying vascular activity with Vascular Laser.
- Target superficial pigment and evening of skin tone with Intense Pulsed Light (IPL).
- Support skin stabilisation and gentle rejuvenation with Laser Genesis Skin Treatment
Book a Consultation with Shape Clinic today!
