What Is Melasma? Causes, Treatment and Why Pigmentation Comes Back

Melasma is a common pigmentation condition that causes flat, brown or grey-brown patches on the face. It often appears across both cheeks, the forehead, the bridge of the nose or the area above the upper lip. The patches are not infectious or cancerous, and they usually do not hurt or itch. Even so, a visible change in facial skin can affect confidence and may become frustrating when it fades slowly or returns after treatment.

Melasma is especially common in women, people with medium to deeper skin tones and people who have a family history of the condition. Sunlight is one of its most important triggers, but hormones, certain medicines and skin irritation can also influence it. Successful care therefore involves more than choosing a brightening cream. It starts with the correct diagnosis, consistent light protection and a treatment plan that suits the depth of pigment and the sensitivity of the skin.

What does melasma look like?

Melasma usually creates irregular but clearly visible areas of increased pigmentation. These patches are commonly symmetrical, which means they appear in a similar pattern on both sides of the face. The colour may range from light brown to deep brown or grey-brown depending on skin tone, pigment depth and recent sun exposure.

Doctors often describe melasma according to its distribution. The centrofacial pattern affects the cheeks, forehead, nose, upper lip and chin. The malar pattern is concentrated over the cheeks and nose. A less common mandibular pattern appears along the jawline. Melasma may occasionally develop on sun-exposed areas outside the face, such as the forearms, but facial melasma is far more typical.

Not every dark patch is melasma. Post-inflammatory hyperpigmentation can follow acne, eczema, a burn, a cosmetic procedure or irritation from a product. Freckles and sun spots tend to form smaller, more defined marks. Pigmentation around the mouth may have several possible causes. If the pattern is new, changing quickly, one-sided, itchy, scaly or associated with another symptom, it deserves a clinical assessment rather than self-treatment.

What causes melasma?

Melasma develops when pigment-producing cells called melanocytes become overactive and make more melanin than the surrounding skin. There is rarely one single cause. Most people have an underlying susceptibility, then one or more triggers repeatedly stimulate pigment production.

1. Ultraviolet and visible light

Sun exposure is the best-established external trigger. Ultraviolet A and B radiation can activate pigment pathways and make existing patches darker. Visible light, including the high-energy visible portion of sunlight, can also worsen pigmentation, particularly in medium to deeper skin tones. This is why melasma may recur after a sunny weekend, regular driving, outdoor exercise or inconsistent sunscreen use, even after a treatment has produced good improvement.

2. Hormonal changes

Melasma is sometimes called the mask of pregnancy because it may appear during pregnancy. Hormonal contraception and hormone therapy can also be associated with it in some people. The relationship is not simple, and stopping a medicine does not guarantee that the pigmentation will disappear. Never stop a prescribed medicine without discussing the risks and alternatives with the clinician who prescribed it.

3. Genetics and skin type

A family history increases the likelihood of melasma. It is also more common in skin that tans easily and in populations with naturally higher melanin activity, including many Indian skin tones. This does not mean that darker skin is unhealthy. It means that pigment cells may respond more strongly to light, heat, inflammation or irritation, and that treatment needs to minimise the risk of causing additional pigmentation.

4. Medicines and irritating products

Some medicines can make skin more sensitive to light or contribute to pigmentation. Harsh exfoliation, fragranced products, repeated scrubbing and unsuitable chemical peels may inflame the skin. Inflammation can intensify discoloration, especially when the skin barrier is already irritated. A long list of active ingredients is not necessarily a better routine.

How is melasma diagnosed?

Melasma is usually diagnosed from its colour, distribution and history. A clinician may ask when the patches began, whether they changed during pregnancy or after a medicine, what skincare products are being used, and how much sun exposure occurs during work or travel. Examination with a dermatoscope or Wood lamp can sometimes provide more information about the pattern and depth of pigment.

Tests are not required for every person. They may be considered when the appearance is atypical or the history suggests another issue. A proper diagnosis matters because treatment for melasma can be unhelpful or irritating when the actual condition is post-inflammatory pigmentation, contact dermatitis, lichen planus pigmentosus or another disorder.

If you want a physician-led assessment rather than trial-and-error skincare, explore iMedi's aesthetic medicine and skin treatment programme. The aim should be to understand the skin first, then choose the least aggressive effective plan.

Melasma treatment starts with photoprotection

No topical treatment can work reliably if light continues to reactivate pigment every day. Use a broad-spectrum sunscreen that protects against UVA and UVB, with an SPF of at least 30. Many people with recurrent melasma benefit from SPF 50+ and a tinted sunscreen containing iron oxides, because tint can improve protection against visible light.

Apply enough product to cover the entire face, ears and other exposed areas. Put it on before going outdoors and reapply during prolonged exposure, sweating or travel. A hat, sunglasses, shade and sensible timing of outdoor activity add protection that sunscreen alone cannot provide. Window exposure during long drives or desk work near strong sunlight may also matter.

Choose a sunscreen that you can use consistently. A technically excellent product that feels unpleasant and remains in the cupboard will not help. People with sensitive skin may prefer a fragrance-free formula. If a new product stings, burns or causes redness, stop and seek advice instead of covering the irritation with more actives.

Which treatments can improve melasma?

Treatment depends on skin type, pregnancy status, sensitivity, previous treatment and pigment pattern. Improvement is gradual. A clinician may use one option or a carefully planned combination.

Hydroquinone and combination therapy

Hydroquinone reduces the formation of melanin and remains an important prescription treatment. A supervised triple-combination cream may combine hydroquinone, a retinoid and a mild corticosteroid for a limited period. This can be effective, but it is not a fairness cream and should not be used indefinitely without review. Incorrect or prolonged use can cause irritation, thinning, steroid-related problems or paradoxical darkening.

Non-hydroquinone topical options

Depending on the person, clinicians may consider azelaic acid, retinoids, kojic acid, cysteamine or other pigment-regulating ingredients. These products have different strengths, side effects and pregnancy considerations. More active ingredients do not automatically produce faster results. A simple routine with cleanser, moisturiser, sunscreen and one suitable treatment is often easier to tolerate and maintain.

Tranexamic acid

Topical or oral tranexamic acid may be considered for selected cases. Oral treatment requires medical screening because it may not be appropriate for people with a history or increased risk of blood clots and can interact with individual health factors. It should never be started from an online recommendation without a qualified prescriber.

Chemical peels, microneedling and lasers

Procedures can help selected patients, but melasma is not simply pigment that can be scrubbed, peeled or lasered away. Overly aggressive procedures can cause inflammation and post-inflammatory hyperpigmentation, particularly in Indian skin. Peels, microneedling and energy-based devices should be chosen conservatively, performed by trained professionals and paired with strict aftercare. Lasers are generally reserved for resistant cases because improvement may be temporary and rebound pigmentation is possible.

Why does melasma come back?

Melasma has a chronic, relapsing tendency. Treatment can reduce excess pigment, but it does not remove the skin's susceptibility to produce more pigment when exposed to light, hormonal signals or inflammation. The visible patches may fade while the biological pathways that created them remain responsive.

Recurrence is especially likely when sunscreen is stopped after the skin clears, treatment is ended suddenly without a maintenance plan, or irritation develops from strong products. Seasonal sunlight, travel, pregnancy and hormonal changes may also reactivate pigmentation. A relapse does not necessarily mean the original treatment failed. It often means melasma needs long-term control, much like other recurring skin conditions.

Maintenance may involve daily photoprotection, a gentler pigment-regulating product used at an appropriate frequency and periodic review. The goal is steady control with healthy skin, not endless peeling or the pursuit of an unrealistically uniform complexion.

A practical daily routine for melasma-prone skin

In the morning, use a gentle cleanser if needed, followed by any clinician-recommended treatment, moisturiser and broad-spectrum sunscreen. A tinted sunscreen may be particularly useful for visible-light protection. If you spend time outdoors, carry it with you so reapplication is realistic.

In the evening, cleanse gently and use only the prescribed or recommended active product at the advised frequency. Follow with moisturiser when needed. Avoid facial scrubs, lemon juice, bleach, unregulated steroid combinations and frequent at-home peels. Patch-test new products and introduce one change at a time so that irritation can be identified quickly.

Take photographs in the same lighting every four to six weeks rather than checking the mirror several times a day. Pigmentation improves slowly, and consistent photographs can show progress more accurately. For more physician-led guidance on preventive and personalised health, visit the iMedi health journal.

When should you consult a doctor?

Seek an assessment when pigmentation appears suddenly, changes rapidly, affects only one side, has an unusual colour or texture, or is accompanied by itching, pain, scaling, hair loss or other symptoms. Consultation is also worthwhile if over-the-counter products have caused burning, if you are pregnant or breastfeeding, or if you are considering prescription creams, oral medicines or procedures.

Bring your skincare products and medicine list to the appointment. Clear information about onset, pregnancy, hormonal therapy, sun exposure and earlier procedures can help the clinician distinguish melasma from similar conditions and build a safer plan.

Frequently Asked Questions (FAQs)

Is melasma dangerous or contagious?

No. Melasma is a benign pigmentation condition and cannot spread from one person to another. A clinician should still check a new or unusual patch because several skin conditions can look similar.

Can melasma be cured permanently?

Melasma can often be improved substantially, but it commonly returns. Long-term sun and visible-light protection, gentle skincare and maintenance treatment provide better control than a short, aggressive course.

What is the best sunscreen for melasma?

Look for a comfortable broad-spectrum sunscreen with at least SPF 30, and consider SPF 50+ for intense or prolonged exposure. A tinted formula with iron oxides can add protection against visible light. The best choice is one you can apply generously and reapply consistently.

Does melasma get worse during pregnancy?

It can. Hormonal changes during pregnancy may trigger new melasma or deepen existing patches. Treatment choices are more limited during pregnancy, so obtain professional advice and focus on careful photoprotection rather than self-prescribing active creams.

Can vitamin deficiency cause melasma?

Melasma is primarily linked with light exposure, hormonal influences, genetics and skin type. A vitamin deficiency is not usually considered its direct cause. Testing should be guided by symptoms and clinical history rather than pigmentation alone.

How long does melasma treatment take?

Some people notice improvement within eight to twelve weeks, while deeper or long-standing pigmentation may take longer. Results depend on the diagnosis, treatment, tolerance and daily light protection. Faster is not always safer.

Can chemical peels or lasers make melasma worse?

Yes, if they create too much inflammation or are unsuitable for the skin type. These procedures can help selected patients, but they should be conservative, professionally supervised and combined with careful aftercare.

Should I stop treatment once the patches fade?

Do not stop or continue a prescription on your own. Your clinician may step down active treatment and use a gentler maintenance plan. Daily photoprotection usually remains important even when the pigmentation is no longer obvious.

Sources and medical guidance

• American Academy of Dermatology: Melasma causes
• American Academy of Dermatology: Melasma self-care
• DermNet: Melasma
• International consensus on melasma management

Medical disclaimer: This article is for general education and does not replace a diagnosis or personalised treatment plan. Pigmentation should be assessed by a qualified clinician before prescription medicines, oral therapy or procedures are started.