Laser and Skin

Melasma: the pigmentation that rewards patience

Melasma is a hormone-linked pigmentation disorder that shows up as symmetrical brown patches on the cheeks, forehead and upper lip, and it can turn darker rather than fade after a strong laser or IPL session. Daily SPF 50 sunscreen with iron oxide, combined with active ingredients used for 3 to 6 months, works more reliably than aggressive energy treatments. Up to 50 percent of pregnant women develop some degree of melasma, and for many of them it fades on its own within months of delivery.

What sets melasma apart from a single sun spot

Melasma appears as a flat, poorly defined patch of brownish discolouration, usually symmetrical across both cheeks, the forehead, the upper lip and the chin. A single age spot is a point; melasma is a pattern. It affects women far more often than men, commonly during pregnancy or while using hormonal contraception, which together account for about 1 in 4 cases. It is also more common in medium to olive skin, described on the Fitzpatrick scale as types 3 to 5, and it tends to start between the ages of 20 and 40.

Three factors act together: hormonal activity, ultraviolet and visible light, and genetic predisposition. Because two of the three cannot be treated away, melasma is not something to remove once and forget. It is a condition to manage, often for years rather than weeks.

Diagnosis is usually visual, sometimes supported by a Wood's lamp examination, which shows whether the pigment sits mainly in the outer skin layer or reaches deeper. That distinction matters: pigment closer to the surface tends to respond better within the same 3 to 6 month window that topical treatment needs, while deeper pigment is more stubborn and more likely to need a longer plan.

Why strong laser and IPL often make it worse

For an isolated sun-induced spot, a laser pulse breaks up the pigment and the skin settles down, often within 1 to 3 sessions. Melasma behaves differently: the pigment cells themselves are already overactive, and a strong energy pulse can push them into producing even more melanin. The result is a patch that returns 4 to 6 weeks later looking darker than before treatment, a reaction dermatologists call postinflammatory hyperpigmentation.

This is why clinicians who use light-based devices on melasma choose low fluence, wider intervals between sessions, often 4 weeks or more, and frequently skip energy devices altogether in favour of topical treatment first. Any procedure on a pigmented patch should sit with a suitably trained doctor, not be the first step tried at home.

Recurrence after any energy-based treatment is common on melasma specifically: several studies report relapse in roughly half of treated patients within about 12 months once sun protection lapses. That pattern is one reason many dermatologists reserve lasers for a stubborn patch that remains after 3 to 6 months of disciplined topical care, rather than as a first move.

Why sun protection looks different here

Most pigmentation problems only need protection against UV rays. Melasma also reacts to visible light, particularly the blue portion of the spectrum, which is why some people see no improvement even while using a high SPF sunscreen that filters UV alone. Visible light can trigger pigmentation that lasts longer and looks more intense than UV exposure by itself.

Mineral filters based on iron oxide address that gap. They are recognisable by a slight tint in the product, since effective coverage of visible light is never completely colourless. For melasma specifically, a tinted SPF 50 sunscreen is not a cosmetic preference. It is part of the treatment itself, alongside the active ingredients used for 3 to 6 months.

Heat also stimulates pigment production. Saunas, hot baths, cooking over a hot stove and long drives with direct sun on the face are not minor details for people managing melasma. Tracking when a patch worsens often reveals a pattern tied to heat exposure within hours, rather than to sun exposure alone.

What actually works

The first layer is sun protection, every day, with a broad-spectrum SPF of at least 50, including in winter and under cloud cover. Melasma reacts to UV exposure well below the level that causes visible sunburn. Reapplication matters too: dermatology guidance recommends applying sunscreen 15 to 30 minutes before going outside and topping it up roughly every 2 hours of exposure.

The second layer is active ingredients, used consistently for months rather than weeks. Azelaic acid, vitamin C and niacinamide are common over-the-counter options; hydroquinone, often at a 4 percent concentration, and tranexamic acid are used under medical supervision. Hydroquinone and retinoid creams such as tretinoin are avoided during pregnancy and breastfeeding, since they can affect the developing baby, so azelaic acid is usually the fallback in that period. A realistic timeline is 3 to 6 months of daily use, and triple-combination creams (hydroquinone, a retinoid and a mild steroid) show 60 to 80 percent improvement over that period, not within the first 4 weeks.

The third layer is patience at the right moments. In pregnancy-related melasma, up to 50 percent of cases fade on their own within months of delivery, and treating aggressively during that window risks more than it gains.

A realistic order of treatment and why relapses happen

The most reliable plan runs in a fixed order. Step 1 is daily protection, as above. Step 2 is an active ingredient used without interruption for 3 to 6 months. Step 3, a cautious procedure such as a mild peel or a very low energy laser, is added only if a visible patch remains after that period, and only under a dermatologist's supervision.

Starting with a device before the skin has had 3 to 6 months of protection and active ingredients usually backfires. Starting with protection first shows, after about 3 months, how much pigment genuinely remains, so any procedure that follows is targeted rather than a blanket treatment of the whole area.

Relapse is part of the condition, not a treatment failure. A summer holiday, a change in hormonal medication, or stopping active ingredients for a few weeks can all bring the discolouration back, sometimes within 4 to 8 weeks. Most people who manage melasma well simply restart the same routine rather than escalate to something stronger.

What actually changes the course of melasma

Frequently asked

Does melasma go away after pregnancy?

In some women it fades within months of delivery as hormone levels settle, though up to 50 percent of pregnant women develop it in the first place. Aggressive treatment during pregnancy or shortly after carries more risk than benefit.

Why did my melasma get darker after a laser treatment?

Because the pigment cells in melasma are already overactive, and a strong pulse can trigger postinflammatory hyperpigmentation, sometimes within 4 to 6 weeks. Lower energy, wider intervals or purely topical treatment usually avoid this.

What SPF do I actually need?

A broad-spectrum SPF of 50 or higher, reapplied roughly every 2 hours in direct sun. Look for iron oxide in the formula, since plain UV filters do not block the visible light that also drives melasma.

How long before a treatment plan shows results?

Most active ingredients need 3 to 6 months of consistent daily use before you can judge whether they are working. Stopping after 4 weeks means judging the product before it has had a real chance.

Is melasma the same as an age spot?

No. An age spot is a single, sharply defined mark from accumulated sun exposure and often responds to laser in 1 to 3 sessions. Melasma is a broader, hormonally driven pattern that behaves differently.

Who should treat melasma with a laser or IPL device?

A dermatologist experienced specifically with melasma, not a generic light-based treatment provider. The wrong device or setting can make the patches more resistant to future treatment.

Sources

• Melasma (StatPearls) · risk factors, iron oxide sunscreens, laser and postinflammatory hyperpigmentation
• Melasma: overview and treatment · SPF guidance, triple-combination therapy, treatment timeline
• Melasma · clinical features, pregnancy link, treatment response
• Melasma patient information leaflet · British Association of Dermatologists, sun protection and pregnancy course

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This guide is for general information. It does not replace medical or professional cosmetic advice or an examination.