Melasma

Melasma is a form of hyperpigmentation caused by overactive melanocytes, the pigment-producing cells in the skin. Unlike standard dark spots, melasma tends to be symmetric, diffuse, and deeper, making it more resistant to treatment.

It is sometimes referred to as the mask of pregnancy, though it affects anyone, including men, and can be triggered by a wide range of internal and external factors.

Melasma can appear in three patterns:

• Epidermal Melasma: Pigment sits in the upper skin layers. Responds best to treatment.
• Dermal Melasma: Pigment lies deeper. More stubborn and slower to improve.
• Mixed Melasma: Combination of both, the most common type.

Melasma is highly reactive, meaning even mild heat, UV exposure, or hormonal fluctuations can cause it to darken.

Melasma develops due to a combination of triggers. Understanding them helps guide treatment and prevention.

1. Hormones

Hormonal shifts significantly influence melanocyte activity.
Common triggers include:

• Pregnancy
• Oral contraceptives
• Hormone replacement therapy
• Thyroid disorders

These hormonal changes make melanocytes more sensitive to UV light and heat.

2. Sun Exposure

This is the strongest external trigger.
UV light stimulates pigment production, darkens existing melasma, and causes rapid recurrence even after treatment.

3. Heat and Infrared Light

Heat from cooking, saunas, hot yoga, strong sun, and even laptops can worsen melasma by activating inflammation and blood flow.

4. Genetic Predisposition

If close family members have melasma, your risk is higher.

5. Skin Inflammation

Any irritation such as harsh exfoliants, burns, or aggressive treatments can cause post-inflammatory hyperpigmentation that mimics or worsens melasma.

6. Lifestyle and Environmental Triggers

• Stress
• Pollution
• Inadequate sun protection
• Certain medications

Melasma often results from several triggers working together, which is why treatment requires a multi-layered approach.

Melasma management is about consistency, protection, and trigger avoidance. Prevention is just as important as treatment.

1. Sun Protection

This is the number one rule.

• Use SPF 50 daily, even in winter or indoors.
• Choose mineral sunscreens containing zinc oxide or titanium dioxide for better pigment protection.
• Reapply every two hours when outdoors.
• Wear hats, sunglasses, and opt for physical shade.

Consistent sun protection alone can noticeably improve melasma over time.

2. Heat Avoidance

Melasma reacts to heat even without sun.

• Avoid hot yoga, saunas, steam rooms.
• Reduce exposure to hot ovens and hobs.
• Choose lukewarm water instead of hot when washing your face.

3. Gentle Skincare

Melasma worsens when the skin barrier is damaged.

• Use gentle cleansers.
• Avoid scrubs, harsh exfoliants, and irritating products.
• Support the barrier with ceramides, niacinamide, hyaluronic acid, and peptides.

4. Anti-Inflammatory Lifestyle Choices

Inflammation fuels pigment.

• Eat antioxidant-rich foods such as berries, leafy greens, and healthy fats.
• Minimise alcohol and smoking.
• Manage stress through exercise, mindfulness, or sleep optimisation.

5. Consistent Use of Pigment-Safe Medical Skincare

Daily use of pigment-regulating products is essential for long-term control.

1. Medical-Grade Skincare

High-quality, medical-grade skincare is essential for reducing pigmentation, controlling melanocyte activity, and maintaining long-term skin clarity.

One of the most effective systems is the OBAGI Nu-Derm® Rx system, which combines potent actives specifically formulated to fade stubborn pigmentation and even skin tone safely under clinical guidance.

Key Depigmenting Ingredients

• Hydroquinone (4–7%): Gold-standard topical depigmenting agent; inhibits melanin production and visibly fades dark spots.
• Arbutin: A gentler alternative that reduces tyrosinase activity to lighten hyperpigmentation without irritation.

Supporting Ingredients

• Vitamin C: Brightens skin and provides antioxidant protection
• Niacinamide: Strengthens the skin barrier and improves overall tone
• Retinoids: Accelerate cell turnover to shed pigmented cells
• Tranexamic Acid: Reduces vascular and hormonal triggers of pigmentation

Benefits

• Gradual and reliable fading of pigmentation
• Reduces recurrence of dark spots
• Improves overall skin clarity and tone
• Supports long-term skin health when used consistently

Results

• Noticeable improvement in 6–12 weeks
• Continued enhancement with long-term, supervised use

Downtime

• None if introduced gradually under professional guidance
• Minor irritation possible at the start of treatment, typically temporary

Note: Topical treatments like hydroquinone and arbutin are prescription-strength and should be used under clinical supervision to ensure safe, effective depigmentation and to prevent rebound hyperpigmentation.

2. Chemical Skin Peels

Mild to medium-depth chemical skin peels remove surface pigment, stimulate collagen, and improve penetration of pigment-regulating skincare.

Peels suitable for melasma include mandelic, lactic, and low-strength glycolic.

Benefits:

• Brightens the complexion
• Reduces surface pigmentation
• Improves skin texture

Results:

• Visible improvement within a few sessions
• Works best when combined with medical-grade skincare

Downtime:

• Mild redness and flaking for 1 to 3 days

3. Microneedling

Microneedling stimulates collagen, improves skin texture, and enhances delivery of pigment-correcting serums.

It must be performed cautiously, as too much inflammation can worsen pigment.

Benefits:

• Refines texture
• Supports deeper penetration of brightening actives
• Strengthens skin structure

Results:

• Gradual improvement over several sessions

Downtime:

• Temporary redness for 1 to 2 days

4. Skin Boosters and Polynucleotides

Hydrating injectables like skin boosters and polynucleotides improve skin quality, reduce inflammation, and support healing.

While not melasma cures, they improve overall clarity and reduce reactivity.

Benefits:

• Healthier, more resilient skin
• Better absorption of topical treatments
• Reduced dullness

Results:

• Visible in 2 to 4 weeks

Downtime:

• Minimal

5. Tranexamic Acid (Topical or Oral)

A powerful melasma treatment that reduces excess pigment by calming inflammation and blood vessel activity.

Prescription oral TXA may be used in selected cases under medical supervision.

Benefits:

• Excellent for hormone-driven melasma
• Reduces vascular redness contributing to pigmentation

Results:

• Noticeable results in 6 to 12 weeks

Downtime:

• None topically

Treatments Must Be Used with Caution:

Some treatments can worsen melasma if used incorrectly.
These include:

• High-strength chemical peels
• Heat-based lasers
• Aggressive exfoliation

Treatment must be tailored to skin type and melasma depth for safe and effective results.

There is no true surgical treatment for melasma, but advanced medical procedures may be used in severe, resistant cases.

Options include:

• Low-fluence laser therapy
• Fractionated non-ablative lasers
• Prescription oral treatments

These require specialist evaluation and careful aftercare to prevent rebound pigmentation.

• Melasma is chronic but highly manageable with the right approach.
• Sun protection and heat avoidance are essential for preventing flare-ups.
• Medical-grade skincare is the foundation of long-term melasma control.
• Chemical peels, microneedling, and tranexamic acid offer reliable improvement when personalised.
• Consistency and lifestyle choices are just as important as treatments.
• A combined approach always produces the best outcome.

Melasma can be a frustrating and confidence-affecting condition, but with a targeted and consistent routine, results can be transformative. By combining medical-grade skincare, gentle resurfacing treatments, pigment suppressors, sun protection, and lifestyle adjustments, melasma can be significantly reduced and kept under control.

At Dr Hass Clinic, we create tailored treatment plans based on your skin type, triggers, and pigmentation depth, helping you achieve clearer, brighter, and more even-toned skin with safe and effective techniques.