What are the treatment options for melasma?

Melasma often appears as fairly even brown or grey-brown patches, commonly on the cheeks, forehead, upper lip or jawline. Pigment may sit at different depths, and ultraviolet and visible light can keep it active. Pregnancy, hormonal medicines, heat and irritating skincare may also influence it. A clinician will examine the pattern and your recent skincare, medicines and sun exposure before recommending treatment. A diagnosis of melasma does not mean that every dark patch should be treated in the same way.

Use a gentle cleanser, moisturiser and daily sunscreen as the foundation of care; tinted products containing iron oxides may help reduce visible-light exposure. Prescription topical treatment may be used for a defined course, with review for irritation or uneven lightening. Procedures such as a chemical peel, microneedling, laser toning or picosecond laser treatment can be considered only after discussing skin tone, previous reactions and the risk of post-inflammatory darkening. Do not combine several strong treatments at home or apply an unlabelled bleaching product. Improvement is gradual, and maintenance light protection is often needed because pigment can return.

Arrange an assessment if facial patches are new, changing quickly, one-sided, itchy, scaly, bleeding or unlike your usual melasma. Seek advice before treatment if you are pregnant, trying to conceive, breastfeeding, taking hormonal medicines or have a history of strong reactions to skincare. Contact the treating clinic promptly after a procedure for increasing pain, blistering, spreading redness, swelling or pus. A dermatologist can also reassess a patch that does not behave like the rest of the pigmentation.

Ask which pigment depth and triggers seem relevant, whether a topical medicine is suitable for you, how long to use it, and what symptoms should prompt a pause. If a procedure is suggested, ask how it may affect your skin tone, what preparation is needed and how sun exposure will be managed afterward.