Melasma is one specific type of pigmentation: symmetrical, driven by hormones and light, and prone to coming back. Other pigmentation, such as sun spots or marks left after spots, has different causes and responds to different treatment. Because a treatment that helps one can worsen the other, the diagnosis matters before anything else is done, which is why every skin plan at Aarva starts with a doctor looking properly.
What is melasma, exactly?
Melasma is a common, long-term condition that causes brown or greyish-brown patches, usually on the cheeks, forehead, upper lip, nose and chin. The patches tend to be symmetrical, appearing on both sides of the face in a similar pattern.
It is much more common in women, and more common in people with medium to darker skin tones. Known triggers include:
- Sunlight, including the visible light that gets through ordinary sunscreens
- Hormonal changes, such as pregnancy or hormonal contraception
- A family history of melasma
- Heat, and some skincare or cosmetic products that irritate the skin
Melasma is not dangerous and is not a sign of anything serious. But it is persistent. It often fades and returns with the seasons, and it can reappear even after good results. You can read more on our melasma page.
What other kinds of pigmentation are there?
“Pigmentation” is a broad word for any area of skin that is darker than the skin around it. The most common types we see are:
Sun spots (solar lentigines)
Flat, well-defined brown marks on areas that have had years of sun, such as the face, hands and chest. They are usually scattered rather than in symmetrical patches, and they are often more stable than melasma once treated.
Post-inflammatory hyperpigmentation
Dark marks left behind after spots, eczema, a burn, an insect bite or an overly aggressive treatment. They follow the pattern of whatever caused the inflammation and often fade slowly on their own over months.
Freckles
Small, light brown marks that darken in summer and fade in winter. They are harmless and often genetic.
Many people have more than one type at the same time, which is one reason self-diagnosis from photographs is so unreliable. Our pigmentation page covers these in more detail.
Related readingWhen a mole needs a doctor to look at itRead the article →Dr Shivani’s Note
The mistake I see most often is melasma treated as though it were ordinary sun damage, with heat-based treatments that leave it darker than before. If your patches are symmetrical and flare with sun, heat or hormones, have a doctor look properly before anything is booked.
Dr Shivani MalhotraMBChB, MRCGP · GP, Skin and Regenerative Medicine Lead
Why does the difference change the treatment?
In melasma, the pigment-producing cells are easily overstimulated. Heat, inflammation and irritation can all make them produce more pigment, not less.
This is why a laser or intense light treatment that works well on a sun spot can, in someone with melasma, lead to the patches returning darker than before. It is also why strong peels, harsh scrubs or at-home devices can leave people with melasma worse off.
By contrast, a well-defined sun spot on otherwise healthy skin may respond well to a carefully chosen laser, such as our UltraClear laser, after a doctor has confirmed what it is.
So the question is never just “how do I get rid of my pigmentation?” It is “which pigmentation is this, and what will this skin tolerate?”
What does melasma treatment usually involve?
Melasma is managed rather than cured. A realistic plan usually has layers:
- Daily sun protection: a broad-spectrum, high-factor sunscreen, and often a tinted one containing iron oxides, which helps block visible light. Hats and shade help too.
- Removing triggers where possible: this might mean a conversation about hormonal contraception with your doctor, or stopping products that irritate.
- Topical treatments: medical-grade skincare and, where appropriate, prescription treatments that reduce pigment production. These are medicines we can discuss at your appointment.
- Procedures, selected carefully: some people benefit from a depigmentation treatment such as Cosmelan or gentle chemical peels. These are added only when the skin is ready.
- Maintenance: because melasma tends to return, a long-term plan to keep it controlled is part of the treatment, not an afterthought.
Improvement usually takes months. We will be honest with you about what is realistic for your skin.
When to see a doctor sooner
Most brown marks on the face are harmless. But some skin cancers, including a slow-growing type of melanoma that appears on sun-damaged facial skin, can look like a flat brown patch. Please see a doctor promptly, through your NHS GP or with us, if a pigmented area:
- Is new and growing, or changing in shape, size or colour
- Has an irregular or blurred edge, or several shades of brown, black, grey or pink
- Bleeds, crusts, itches or becomes raised
- Looks different from your other marks
- Appears on only one side of the face, rather than in a symmetrical pattern
Our guide on when a mole needs a doctor to look at it explains more. Pigmentation should never be treated cosmetically until anything concerning has been checked.
This list is not exhaustive. If you are not sure about something, see a doctor.
How we approach this at Aarva
Your appointment starts with a doctor, not a device. We take a history, including pregnancies, hormonal contraception, sun exposure, previous treatments and what has helped or made things worse.
We examine the skin in good light and use our AURA 3D skin analysis to map pigment patterns that are not always visible to the eye. This helps us see whether we are looking at melasma, sun damage, marks after inflammation, or a mix. It supports a doctor’s judgement; it does not replace it.
If anything looks like it needs checking for medical reasons, that comes first. Otherwise, you leave with a written treatment plan with clear pricing. There is no pressure to book on the day, and if we think a treatment will not help your pigmentation, we will say so. You can read what happens at a skin consultation and on our what to expect page. If you are weighing up options, our guide to questions to ask before any skin treatment may help, and you can explore our wider skin care.
Questions patients ask
Can melasma be cured?
Melasma is usually a long-term condition that is controlled rather than cured. Many people see good improvement with sun protection, the right topical treatment and carefully chosen procedures, but it can return, especially with sun exposure or hormonal change, so maintenance is part of the plan.
Can laser treatment make melasma worse?
Yes, it can. Heat and inflammation can stimulate melasma pigment cells, and some people find patches return darker after laser or intense light treatment. Laser is not ruled out for everyone, but it needs a doctor’s assessment and a cautious approach.
Is melasma linked to pregnancy?
It often is. Melasma is common during pregnancy and may fade afterwards, although it does not always. Many treatments are not suitable during pregnancy or breastfeeding, so please tell your doctor if you are pregnant, planning a pregnancy or breastfeeding.
How long before I see a difference?
Most people need at least two to three months of consistent treatment and sun protection before a clear change. Your written plan will set out what to expect and when we will review progress.
If you are not sure what your pigmentation is, the first step is a proper look by a doctor. You can book a consultation, or if you would like help working out where to begin, try find your starting point.
This article is general information and does not replace a consultation with a doctor.
