Melasma in later life: what should you know?

Melasma creates flat areas of increased pigment, commonly with fairly even colour and no change in surface. In later life, sun-damaged skin, medication-related pigmentation, marks after inflammation, and other lesions may resemble it. A clinician considers whether the patch is new or longstanding, whether it is symmetric, and whether it has scale, crust, thickness, or a changing border. Age alone does not identify the cause, and a familiar-looking mark can still merit review when it changes.

Arrange a skin examination before starting a strong pigment routine. Bring a list of medicines and products, and mention past rashes, procedures, or repeated sun exposure. Use broad sun protection, hats or clothing when practical, gentle cleanser, and moisturiser. Avoid picking, abrasive scrubs, and unprescribed steroid mixtures. If melasma is confirmed, options can include a tailored skin-brightening treatment, chemical peel, microneedling, or laser toning, balanced against sensitivity and healing time.

Seek a timely dermatology review for a spot that changes in size, colour, shape, or texture, or that itches, bleeds, crusts, hurts, or fails to heal. Prompt examination is especially sensible when a mark is new or clearly different from nearby pigmentation. These features do not prove a serious condition, but they should be assessed rather than masked with cosmetic products.

What diagnoses fit this pattern and texture? Could any medicine or previous inflammation be contributing? Should the area be photographed for monitoring? Which pigment treatment is appropriate for mature or sensitive skin?