Melasma is a common skin condition that causes brown or greyish-brown patches, usually on the cheeks, forehead, upper lip and nose. It's more than surface pigmentation. This complex, stubborn condition involves melanocytes (the cells that make pigment), hormones, sunlight and even the skin's underlying structure. Understanding what triggers melasma can help you make better decisions about prevention and treatment.
5 surprising facts about melasma
1. Visible light can make melasma worse
It isn't just UV rays that affect pigmentation. High-energy visible light from the sun can also worsen melasma, particularly in darker skin tones. That's why many people with melasma do better with a tinted mineral sunscreen: the iron oxides that give it colour help block visible light, which clear sunscreens don't.
2. Melasma can involve more than excess melanin
Research suggests that skin affected by melasma can also show changes in the dermis, the deeper layer of the skin, including more blood vessels and changes to the skin's supporting structures. This helps explain why melasma can be complex to treat and, at times, stubborn to remove.
3. Pregnancy can trigger long-lasting pigmentation
Hormonal changes during pregnancy can switch on the pigment-producing cells called melanocytes, which is why melasma is sometimes called the "mask of pregnancy." Birth control pills and hormone therapy can trigger it too. Although melasma may fade after childbirth, the pigmentation can persist for years in some women.
4. Melasma can come back even after successful treatment
Melasma is chronic, and it can return. Sun exposure, visible light and hormonal changes can reactivate the pigmentation, which makes consistent sun protection and maintenance skin care important even when your skin looks clear.
5. Melasma can sit deeper than the skin's surface
Melasma can involve different depths of pigmentation. When pigment sits near the surface, the patches tend to look light to medium brown. When it's located deeper in the skin, it may look greyish brown and can be more difficult to improve with topical skin-lightening products. Many people have a mix of both.
Who gets melasma?
Melasma is far more common in women, because estrogen and progesterone play a big role in triggering it, but men can get it too. It shows up most often in people with medium to darker skin tones, in people who spend a lot of time in the sun, and in people with a family history of it.
Is it melasma or a sun spot?
Melasma is often mistaken for a sun spot. A sun spot is usually a single, well-defined mark, while melasma tends to show up as larger patches, often with a matching "twin" patch on the other cheek, and it can seem to appear almost overnight. Rita wrote about how she tells them apart in Do I suffer from melasma? If it turns out to be a sun spot, sun spot removal is a different, simpler treatment.
Have you tried prescription creams and skin care, and nothing is working?
You're not alone. Over the years, many clients have told Rita that the skin-lightening products their doctors prescribed didn't help with deeper melasma, and a lot of people end up with a collection of creams and little improvement. That usually happens when the pigment sits deeper than a cream can reach.
How does Pure Light Laser treat melasma?
At Pure Light Laser, Rita brings over 30 years of experience in laser and skin care, and she has treated over 3,000 people with melasma. For some people with stubborn melasma, a conservative 1540 erbium fractional laser approach combined with an appropriate skin-lightening regimen may be considered. Treatments are usually spaced about a month apart, and most people need at least two.
Laser treatment is not suitable for everyone with melasma, so an individual assessment is essential. Too much heat can make melasma darker, which is why settings are kept conservative, and why Rita doesn't rely on chemical peels or microdermabrasion alone to treat it. At your free 45-minute consult, she looks at your skin, the depth of the pigment and your history, and tells you whether laser is the right option for you.
How can you keep melasma from coming back?
- Wear a broad-spectrum, tinted mineral sunscreen (SPF 30 or higher) every day, and reapply it when you're outdoors.
- Add a wide-brimmed hat and shade on sunny days. Heat on its own can also darken melasma, so hot yoga and saunas are worth keeping an eye on.
- Keep using a skin-lightening product between treatments. Rita can recommend one from the Pro-Derm range.
- If your melasma started with birth control or hormone therapy, talk to your doctor about your options.
Melasma questions
Can melasma be cured?
Melasma can be lightened a lot, but because it's chronic it can come back with sun, visible light or hormonal changes. Most people manage it long term with treatment, daily sun protection and maintenance skin care.
How many laser treatments does melasma need?
Most people need at least two treatments spaced about a month apart, and sometimes more when the pigment is deep. The exact plan depends on your skin, which Rita assesses at your consult.
Does sunscreen help melasma?
Yes, it's the most important step. A tinted mineral sunscreen helps the most, because it protects against both UV and visible light, the two main triggers that darken melasma.
Is laser treatment safe for melasma?
It can be, with the right approach and an experienced technician. Melasma reacts badly to too much heat, so conservative settings matter, and not everyone is a good candidate. That's why an assessment always comes first.
Have questions about your skin? Book a free 45-minute consult with Rita, or call 604-568-8041.
