Top Questions Patients Ask About Melasma: Answered by Medicura Dermal Clinician
Melasma is one of the most common skin conditions patients ask about in dermatology clinics, yet it remains one of the most misunderstood. Characterized by patches of brown or grayish pigmentation, usually on the cheeks, forehead, and upper lip, melasma can affect confidence just as much as it affects appearance. Many patients come in asking the same set of questions: What causes melasma? Is it permanent? How can it be treated?
At Medicura, our dermal clinicians spend a great deal of time explaining this condition to patients. Unlike a rash or acne breakout that may clear within weeks, melasma is chronic and often stubborn. It behaves differently in different people, influenced by sun, hormones, and even stress (Miot et al., 2009). That’s why no single cream or laser can be called a universal cure.
In this guide, we’ve compiled the top questions patients ask about melasma and provided expert, evidence-based answers. From causes to treatment options, lifestyle tips to myths, you’ll gain a clearer understanding of how to manage this condition with patience and realistic expectations.
What Is Melasma?
Melasma is a chronic skin condition marked by flat, discolored patches that are most often brown, gray-brown, or bluish in tone. It usually appears on sun-exposed areas of the face such as the forehead, cheeks, nose bridge, and upper lip, but it can also affect the forearms, chest, or neck (Ogbechie-Godec & Elbuluk, 2017). Unlike freckles or sunspots that may fade with time, melasma tends to persist and can flare up repeatedly.
The exact cause of melasma isn’t fully understood, but we know it is driven by an overproduction of melanin—the pigment that gives skin its color—by melanocytes (Miot et al., 2009). This overactivity can be triggered by a variety of factors: sun exposure, hormonal fluctuations, pregnancy (often called the “mask of pregnancy”), certain medications, and even heat or stress (Kang & Ortonne, 2010).
It’s important to recognize that melasma is not dangerous or contagious (Grimes et al., 2005). Instead, it is primarily a cosmetic and psychological concern. For many patients, the frustration lies in how stubborn it is and how it can return even after improvement. That’s why managing melasma often requires a combination of medical treatments, consistent sun protection, and lifestyle awareness, rather than a one-time fix (Passeron et al., 2019).
What Causes Melasma?
Melasma is not caused by a single factor—it’s a multifaceted condition influenced by both internal and external triggers (Sarkar et al., 2014). Understanding these root causes is essential, because effective treatment doesn’t just lighten existing pigment; it also focuses on preventing new patches from forming.
At its core, melasma happens when melanocytes (the pigment-producing cells in the skin) become overactive. Instead of distributing melanin evenly, they release excess pigment into certain areas, leading to blotchy patches (Miot et al., 2009).
Common triggers include:
Hormonal changes: Pregnancy, oral contraceptives, and hormone replacement therapy are well-known contributors (Kang & Ortonne, 2010).
Sun exposure: Ultraviolet (UV) rays stimulate melanocytes, making existing melasma darker and new patches more likely (Passeron et al., 2019).
Heat and infrared light: Not just UV rays, but also heat from cooking, saunas, or hot climates can exacerbate melasma (Sarkar et al., 2014).
Genetics: A family history of melasma increases the likelihood of developing it (Miot et al., 2009).
Skin irritation: Inflammatory reactions, harsh skincare, or cosmetic treatments can sometimes trigger pigment changes (Ogbechie-Godec & Elbuluk, 2017).
Understanding these causes helps both clinicians and patients design personalized management strategies, whether it’s hormone regulation, sun protection, or choosing gentler skincare (Grimes et al., 2005).
Is Melasma the Same as Other Pigmentation Disorders?
Many patients wonder whether melasma is just another form of “dark spots” or if it’s something entirely different. While melasma falls under the umbrella of pigmentation disorders, it has unique characteristics that set it apart from conditions like sunspots, freckles, or post-inflammatory hyperpigmentation (Sarkar et al., 2014).
How melasma differs:
Appearance: Larger, symmetrical patches with blurry edges (Ogbechie-Godec & Elbuluk, 2017).
Location: Primarily affects the face—cheeks, forehead, nose, and upper lip (Miot et al., 2009).
Triggers: Strong ties to hormones, heat, and genetics (Kang & Ortonne, 2010).
Chronic nature: Persistent and prone to recurrence (Grimes et al., 2005).
In other words, melasma is not just “a stubborn sunspot.” It behaves differently, responds differently to treatment, and requires a tailored approach (Sarkar et al., 2014).
Who Is Most at Risk of Developing Melasma?
Certain groups are more prone due to genetic, hormonal, and lifestyle factors (Miot et al., 2009).
Groups most at risk include:
Women of reproductive age: Around 90% of cases occur in women (Grimes et al., 2005).
Pregnant women: Hormonal surges make it common during pregnancy (Kang & Ortonne, 2010).
People with medium-to-dark skin tones: Fitzpatrick types III–V are more vulnerable (Sarkar et al., 2014).
Individuals with a family history: Genetic predisposition plays a strong role (Miot et al., 2009).
Those with high sun exposure: UV radiation is a major environmental trigger (Passeron et al., 2019).
This awareness helps guide preventive measures such as sunscreen use and gentle skincare.
Can Melasma Go Away on Its Own?
For some people, melasma fades naturally when the trigger behind it is removed, such as after childbirth or discontinuing hormonal medication (Kang & Ortonne, 2010). However, in many cases, melasma is chronic and recurrent, returning with sun exposure, heat, or hormonal fluctuations (Sarkar et al., 2014).
Without consistent sun protection and medical guidance, melasma rarely disappears completely (Passeron et al., 2019).
Is Melasma Dangerous or Just Cosmetic?
Melasma is not dangerous in a medical sense — it doesn’t evolve into cancer or harm the skin structure (Grimes et al., 2005). However, it carries a significant psychological impact, often affecting self-esteem and emotional wellbeing (Ogbechie-Godec & Elbuluk, 2017).
Clinically, it’s benign but chronic. Addressing it holistically—physically and emotionally—helps patients regain confidence and improve quality of life.
How Do Dermatologists Diagnose Melasma?
Diagnosis is usually based on clinical examination and patient history (Miot et al., 2009). Tools such as Wood’s lamp help determine pigment depth (epidermal, dermal, or mixed) (Grimes et al., 2005). In rare cases, a biopsy may be done to exclude other pigmentation disorders (Ogbechie-Godec & Elbuluk, 2017).
Accurate diagnosis ensures the right treatment strategy and prevents worsening through inappropriate interventions.
What Are the Treatment Options for Melasma?
Treatment requires a multimodal approach combining medical-grade topical therapy, procedural interventions, and strict photoprotection (Passeron et al., 2019; Handog et al., 2012).
Topical treatments:
Hydroquinone, azelaic acid, kojic acid, and tranexamic acid reduce melanin synthesis (Grimes et al., 2005).
Combination creams (hydroquinone + tretinoin + corticosteroid) are effective under clinical supervision (Sarkar et al., 2014).
Procedures:
Chemical peels and microneedling improve efficacy when safely performed (Handog et al., 2012).
Low-fluence Q-switched or fractional lasers show benefit but must be used cautiously (Ball et al., 2022).
Sun protection:
Broad-spectrum sunscreen (SPF 50+) is essential daily to prevent UV- and visible-light-induced relapse (Passeron et al., 2019).
Can Lifestyle and Skincare Habits Affect Melasma?
Absolutely. Consistency with sun protection, gentle skincare, and stress management helps prolong results and reduce recurrence (Kang & Ortonne, 2010). Even minor heat exposure or harsh acids can cause flare-ups (Sarkar et al., 2014).
What Results Can Patients Expect from Melasma Treatment?
Melasma improvement is gradual—most patients notice changes within 8–12 weeks of consistent treatment (Grimes et al., 2005). The goal is control and maintenance, not permanent cure (Ogbechie-Godec & Elbuluk, 2017).
Long-term success depends on maintenance therapy and lifestyle care (Passeron et al., 2019).
Conclusion
Melasma can be challenging, but with proper understanding and management, patients can achieve significant improvement. At Medicura, dermal clinicians emphasize realistic goals, consistent sun protection, and professional treatment protocols (Sarkar et al., 2014).
With patience and evidence-based care, melasma can be effectively controlled—restoring not just skin clarity but confidence as well.
Peer-Reviewed References
Grimes PE, Yamada N, Bhawan J. Melasma: Etiologic and Therapeutic Considerations. Archives of Dermatology. 2005;141(12):1458–1467.
Miot LD, Miot HA, Silva MG, Marques MEA. Physiopathology of Melasma. Anais Brasileiros de Dermatologia. 2009;84(6):623–635.
Ogbechie-Godec OA, Elbuluk N. Melasma: An Up-to-Date Comprehensive Review. Dermatology and Therapy. 2017;7(3):305–318.
Passeron T, Lim HW, Goh CL, et al. Photoprotection and Sunscreens in the Management of Melasma: An Evidence-Based Review. Journal of the American Academy of Dermatology. 2019;81(6):1723–1733.
Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N. Melasma Update: A Brief Review. Pigment International. 2014;1(2):70–82.
Kang HY, Ortonne JP. What Should Be Considered in Treatment of Melasma. Annals of Dermatology. 2010;22(4):373–378.
Handog EB, Gabriel TG, Singzon IA. Chemical Peels for Melasma in Asian Skin: A Review. Journal of Cutaneous and Aesthetic Surgery. 2012;5(4):239–247.
Ball A, et al. Laser and Light-Based Treatments for Melasma: A Systematic Review and Meta-Analysis. Lasers in Surgery and Medicine. 2022;54(1):10–23.
These sources reflect the current clinical consensus and research-supported approaches to diagnosing, managing, and supporting patients with melasma.
