Melasma

Melasma is a form of hyper-pigmentation that appears as large brown-grey patches, usually on the cheeks, upper lip, forehead or between the brows. It is symmetrical - it tends to appear on both sides of the face in a mirrored pattern - which is one of the things that distinguishes it from other pigmentation.

When melasma occurs in pregnancy it is called chloasma.

Be clear about what melasma is

Melasma is a chronic, relapsing condition. It is managed, not cured. Any claim that a treatment will permanently clear melasma should be treated with suspicion, including claims made about our own treatments.

Being upfront about this is not pessimism - it is the difference between a plan that works and a course of treatment that leaves you worse off. Melasma is the one pigmentation condition where over-treating reliably makes things worse.

What drives it

Hormones - oestrogen and progesterone. Pregnancy, the oral contraceptive pill and hormone therapy are common triggers.
Ultraviolet light - and visible light, including from screens, which is why sunscreen alone sometimes is not enough.
Heat - melasma can flare with heat, not just with UV.
Genetics - it runs in families.
Skin type - people with olive or darker complexions are more commonly affected.
Some cases have no identifiable trigger.

Melasma is far more common in women than men.

Assessment first

Melasma is diagnosed clinically, and assessment establishes how deep the pigment sits - epidermal, dermal or mixed. That determines what is worth attempting. Dermal melasma responds poorly to most treatments, and knowing that in advance prevents a lot of wasted money.

Assessment also rules out the other things that produce facial pigmentation: post-inflammatory pigmentation, solar lentigines, and - importantly - pigmented lesions that need proper examination rather than cosmetic treatment.

Treatments used for melasma

Depigmenting lotion treatments - topical pigment inhibitors, usually the foundation of the plan
Cosmeceutical skincare - including antioxidants and retinoids
Chemical peels - conservatively, and at appropriate depth
Laser - low-fluence Nd:YAG, Fraxel and erbium are used cautiously; aggressive laser settings commonly worsen melasma
Microdermabrasion
Skin needling
Mineral make-up - both cover and a physical barrier against visible light

Some topical treatments used for melasma are prescription-only and require a doctor's consultation. Several are not suitable in pregnancy or while breastfeeding.

Sun protection is the treatment, not the aftercare

For melasma, daily broad-spectrum sun protection is the single most effective thing you can do, and it needs to continue indefinitely. A tinted or mineral sunscreen with iron oxides also blocks visible light, which ordinary chemical sunscreens do not. Without this, other treatments are working against a driver that never stops.

What results are realistic

With a consistent plan, melasma commonly lightens - sometimes substantially. It also commonly returns, particularly after summer, after a pregnancy, or if topical treatment and sun protection stop.

Epidermal melasma responds better than dermal melasma. Some melasma does not respond meaningfully to any treatment. Individual results vary, and your practitioner should tell you honestly which category yours is likely to fall into before you commit to a course.

Risks

Worsening of the melasma itself - the most important risk. Over-aggressive laser, peels or heat can rebound the pigmentation darker than it started.
Post-inflammatory hyper-pigmentation
Hypo-pigmentation - lighter patches that can be permanent
Redness, irritation, dryness and peeling from topical agents
Contact dermatitis
Scarring and infection with more aggressive treatment
Recurrence - expected rather than exceptional

Tell your practitioner if you are pregnant, breastfeeding, planning a pregnancy, or taking hormonal medication. See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. Because melasma is managed over time, budget for maintenance rather than a one-off course. Cosmetic treatment is not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.