All things Melasma
Understanding Melasma
Melasma is a common form of pigmentation that causes patches of brown, tan or sometimes grey-brown discolouration, most commonly across the cheeks, forehead, upper lip and jawline.
It can be a frustrating skin concern because melasma isn't simply pigmentation sitting on the surface of the skin. It is a chronic pigment condition influenced by the way your skin produces melanin, meaning it can lighten, darken and change over time.
The good news is that with the right approach, melasma can often be significantly improved and kept well managed.
What causes melasma?
There usually isn't one single cause. Melasma develops through a combination of genetics, hormones and environmental triggers.
Common triggers and contributing factors include:
Sun and UV exposure
Visible light
Heat
Hormonal changes
Pregnancy
Some hormonal medications
Genetics and family history
Inflammation and irritation within the skin
You may notice your pigmentation becomes darker during summer, after increased sun exposure, during hormonal changes or when your skin is particularly irritated or inflamed.
Why does melasma keep coming back?
Melasma is generally considered a condition that we manage rather than permanently cure.
Even once pigmentation has faded, the skin can remain predisposed to producing excess pigment. Exposure to UV, visible light, heat, hormonal changes or inflammation can stimulate those pigment-producing cells again.
This is why long-term management and prevention are just as important as treating the pigmentation you can currently see.
Managing melasma
When treating melasma, more aggressive doesn't necessarily mean better.
Trying to remove pigmentation too quickly or repeatedly irritating the skin can create inflammation, which may stimulate further pigment production. Instead, I prefer a gradual approach that supports the health of the skin while carefully targeting pigmentation.
A good melasma plan generally focuses on:
Protecting the skin
Daily broad-spectrum SPF 50+ is one of the most important parts of managing melasma. A tinted sunscreen containing iron oxides may provide additional protection from visible light, which can contribute to pigmentation.
Reducing pigment production
Depending on your skin, homecare may include ingredients such as azelaic acid, niacinamide, vitamin C, alpha arbutin, tranexamic acid or retinoids.
Keeping the skin barrier healthy
A calm, hydrated and resilient skin barrier helps us use corrective ingredients and treatments without creating unnecessary irritation.
Managing inflammation
Over-exfoliating, using too many active ingredients or continually irritating the skin can work against us when treating pigmentation.
Professional treatments
Carefully selected treatments such as customised facials, appropriate peels or skin needling may form part of a longer-term treatment plan. What is suitable will depend on your skin, the type and depth of pigmentation, your homecare and your individual triggers.
What about laser and heat-based treatments?
This is an area where melasma needs particular consideration.
Some laser, light and heat-based treatments may improve pigmentation in appropriately selected cases, while others can potentially trigger or worsen melasma, particularly if they create significant inflammation or heat within the skin.
If you're considering these treatments, it is important to see a practitioner experienced in treating melasma specifically rather than treating it in the same way as general sun pigmentation.
Homecare matters
Professional treatments can be helpful, but what you do between appointments has a huge influence on your results.
Consistent sunscreen, appropriate pigment-supporting ingredients and a routine that keeps your skin healthy will generally be more valuable than occasional aggressive treatments without good homecare.
Melasma management is a long-term process rather than a quick fix.
When should I see a doctor or dermatologist?
Not every brown mark is melasma.
If pigmentation is new, changing, unusual, raised, irregular or hasn't been professionally assessed, it is important to have it checked by a GP or dermatologist before assuming it is melasma.
A dermatologist can also provide prescription treatment options where appropriate, particularly for persistent or more significant melasma.
Treating melasma at Cared For
My approach is to look at the whole picture rather than simply trying to remove visible pigment.
We'll consider your current skincare, sun exposure, skin barrier, inflammation, lifestyle and known triggers before deciding what is appropriate for your skin.
From there, we can create a realistic plan using homecare, skin protection and carefully selected professional treatments to gradually improve pigmentation while keeping your skin healthy.
There is no pressure to do everything at once. Melasma responds best to patience, consistency and a plan that your skin can comfortably maintain long term.