What should you know about dermal melasma treatment?

Melasma causes brown or grey-brown patches, commonly on the cheeks, forehead, nose, or upper lip. Dermal pigment sits deeper than pigment close to the surface, which can make it slower to respond and easier to irritate with aggressive treatment. Hormonal changes, visible light, ultraviolet exposure, and heat may encourage recurrence. Read about [Melasma](/conditions/melasma/) and [Dark Patches On Skin](/symptoms/dark-patches-on-skin/) for context.

A dermatologist may begin with daily broad-spectrum sunscreen, shade, hats, and a pigment-care routine chosen for your skin. Depending on examination findings, options may include prescription creams, [Skin Brightening Treatment](/treatments/aesthetic-procedures/skin-brightening-treatment/), [Chemical Peel](/treatments/aesthetic-procedures/chemical-peel/), [Microneedling](/treatments/aesthetic-procedures/microneedling/), or carefully selected [Laser Toning](/treatments/laser-and-energy/laser-toning/). Deeper pigment and darker skin tones need cautious settings because inflammation can darken patches. Do not add several active products or procedures at once.

Arrange a skin assessment when pigmentation is new, changing, one-sided, itchy, painful, bleeding, or unlike your usual patches. Seek prompt advice after a procedure if redness, swelling, blistering, crusting, or pain is worsening rather than settling. A clinician can confirm melasma before treatment because other causes of facial darkening need different care.

Ask whether the pigment appears dermal or mixed, which light exposures may be contributing, how long to test one treatment, and what signs mean you should pause a product. Discuss pregnancy, breastfeeding, previous reactions, and your history of dark marks after irritation before starting treatment.