Melasma

Melasma is not harmful and is not a sign of anything serious, but it can be persistent and can affect confidence. It often gets darker in the summer and fades a little in the winter.

There is no permanent cure, but with the right combination of treatment and sun protection most people see a clear improvement.

Common areas include:

• the cheeks
• the forehead
• the upper lip
• the bridge of the nose and the chin
• less often, the forearms and neck

Melasma does not itch or hurt. A single irregular mark, or pigmentation that is raised, bleeding or changing quickly, should be checked by a dermatologist.

Your dermatologist will examine your skin, sometimes with a dermatoscope or a special lamp, and ask about triggers such as pregnancy, hormones and sun exposure. This also rules out other causes of pigmentation, such as sun damage, freckles or darkening after inflammation. A skin biopsy is rarely needed.

Treatment works best when several approaches are combined, and it usually takes a few months to see a difference.

Treatments include:

• Daily high-factor, broad-spectrum sunscreen, ideally a tinted one that also blocks visible light
• Prescription lightening creams, such as hydroquinone, sometimes combined with a retinoid and a mild steroid
• Other creams and serums, such as azelaic acid, tranexamic acid and vitamin C
• Tranexamic acid tablets, for selected patients
• Medical-grade skincare, such as SkinCeuticals

Lasers and light treatments can help in some cases, but they can also make melasma worse, so your dermatologist will only suggest them where they suit your skin. Melasma often returns, so ongoing sun protection and maintenance treatment are important.