Melasma
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Skin Health Library · Conditions
Melasma
A stubborn, relapsing condition where the wrong treatment can backfire — so care and restraint come first.
Melasma is a common pigment condition that produces symmetric brown or gray-brown patches, usually on the cheeks, forehead, upper lip and bridge of the nose. It’s driven by a combination of genetics, hormones (pregnancy, oral contraceptives) and — critically — ultraviolet and visible light, plus heat.
Here is the most important thing to understand: melasma is chronic and relapsing. It is managed, not cured, and it is unusually easy to make worse. Aggressive lasers, heat and over-treatment can trigger flares and rebound pigmentation. That’s why a careful, conservative, skincare-led approach — not the most powerful device available — is the standard of thoughtful care.
The Governing Principle
With melasma, avoiding harm is half the treatment.
At A Glance
What Helps — and What Can Worsen It
With melasma, avoiding harm is half the treatment. Heat and aggressive light are common triggers.
Melasma, simplified
Management, not cure — protect first, treat gently
What genuinely helps
- Rigorous daily photoprotection
- Tinted / iron-oxide sunscreen (blocks visible light)
- Gentle topical pigment agents (under care)
- Patience and consistency
- Addressing hormonal contributors where possible
What can make it worse
- Aggressive or hot lasers
- Heat (including from devices and sun)
- Sun and visible-light exposure
- Picking or harsh scrubs
- Over-treatment and irritation
Educational summary only. Melasma is chronic and relapsing; treatment is individualized and prioritizes not worsening it.
The DetailsUnderstanding Melasma
What makes melasma different from ordinary dark spots:
Hormonally Influenced
Often triggered or worsened by pregnancy and hormonal contraceptives — hence the nickname ‘the mask of pregnancy.’
Light-Sensitive
Driven by UV and visible light, so ordinary sunscreen alone may not be enough.
Heat-Sensitive
Heat can trigger it — a reason aggressive, hot lasers often backfire.
Chronic & Relapsing
It’s managed over time and tends to return, especially with sun; there is no one-time cure.
Symmetric Patches
Typically appears symmetrically on the cheeks, forehead and upper lip.
Easily Worsened
Over-aggressive treatment can cause rebound pigmentation that’s harder to treat.
The OptionsHow Melasma Is Managed
Melasma management is deliberately conservative. The aim is to lighten and control it without provoking a flare — which means leading with protection and gentle topicals, and treating procedures with real caution.
Photoprotection, seriously
Daily broad-spectrum protection — ideally a tinted / iron-oxide sunscreen that also blocks visible light — is the single most important treatment. See sunscreen guidance.
Gentle topicals
Pigment-regulating agents used under medical guidance, as part of a careful skincare plan, are the mainstay.
Procedures — with caution
Certain gentle procedures may help selected patients, but aggressive lasers and heat are generally avoided because they can worsen melasma. This is a clear example of when laser isn’t the right tool — at least not first, and not aggressively.
Related reading
Restraint as Expertise
The most powerful device is often exactly the wrong choice here.
How We DecideEvidence-Based Practice
Aesthetic medicine changes rapidly, and novelty alone is not evidence. At Onassis Skin Health, treatment and skincare protocols are developed with reference to peer-reviewed medical literature and respected clinical guidance — then interpreted for the individual in front of us.
Research does not replace clinical judgment. It informs it.
Published evidence is read in the context of your anatomy, skin type, medical history, risk profile, lifestyle and desired outcome. Product and technique selection, dosing or placement, and pre- and post-care all follow from that combination of evidence and individualized assessment — not from what is simply popular or available for purchase.
When AppropriateA Careful Plan
Melasma is managed with a gentle, protection-first plan — procedures are added only cautiously:
+ Rigorous Photoprotection
Tinted, broad-spectrum sunscreen against UV and visible light — the foundation of control.
+ Gentle Medical Skincare
Pigment-regulating topicals under guidance, chosen to lighten without irritating.
+ Cautious Procedures
Only gentle, individualized procedures where appropriate — never aggressive heat or lasers as a first move.
Combinations are recommended only when each element contributes meaningfully to your goals. Sometimes the right plan is a single, well-chosen treatment — and sometimes it is choosing not to treat at all.
What to ExpectManaging, Not Curing
Realistic expectations are essential: melasma is controlled rather than cured, and it tends to relapse with sun and heat. The safest path is consistent protection and gentle treatment, with any procedures approached cautiously. We’ll be candid about what’s achievable and focused on not making it worse.
QuestionsFrequently Asked
Can melasma be cured?
No — it’s chronic and relapsing. It can be managed and lightened, but it tends to return, especially with sun and heat.
Will laser fix my melasma?
Aggressive lasers often worsen melasma. Some gentle procedures help selected patients, but protection and topicals come first.
Why isn’t my sunscreen working?
Melasma reacts to visible light too — a tinted/iron-oxide sunscreen that blocks visible light is usually needed.
Is it related to hormones?
Often — pregnancy and hormonal contraceptives can trigger or worsen it.
How long until I see improvement?
Gradually, over weeks to months of consistent, gentle care — with maintenance to prevent relapse.
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