Refractory Melasma: What to Know

Melasma causes brown or grey-brown patches, commonly on the face, and can be influenced by ultraviolet and visible light, heat, hormones, and skin irritation. Persistent pigment does not necessarily mean treatment has failed; the trigger may still be present, the diagnosis may need review, or the skin may be reacting to an overly irritating routine. A clinician may assess whether the colour is superficial or deeper and distinguish melasma from other causes of dark patches or uneven skin tone.

Use broad-spectrum sun protection every day, consider a hat or shade, and avoid deliberate tanning and excess heat when these worsen your patches. Keep products gentle and do not pick or scrub the area. A dermatologist may review prescription options and discuss skin brightening treatment, chemical peel, microneedling, or laser toning. These procedures can irritate pigment-prone skin, so selection, settings, preparation, and aftercare matter. Improvement is often gradual, and maintenance may be needed.

Arrange review when patches change quickly, become scaly, bleed, itch persistently, hurt, or appear in an unusual pattern. Contact your clinician after treatment if redness, swelling, blistering, crusting, or darkening is worsening rather than settling. Urgent care is appropriate for facial swelling or breathing difficulty after a product or procedure.

Ask whether the diagnosis is secure, which triggers may be active, how long to assess a revised plan, which option fits your skin tone, and how post-treatment darkening will be prevented or managed.