Understanding Melasma, Treatment Options and Why It Can Return
Melasma is a common pigmentation condition that typically appears as symmetrical brown or grey-brown patches on areas such as the cheeks, forehead, nose, upper lip and chin.
It is particularly common in women and may become more noticeable during pregnancy or periods of hormonal change. However, melasma can also affect men.
Unlike isolated freckles or sunspots, melasma is often influenced by several factors at the same time. These may include hormones, ultraviolet exposure, heat, visible light, genetics and inflammation.
This is why melasma treatment is rarely as simple as removing visible pigment with one laser session.
At Radium Medical Aesthetics, melasma is approached as a chronic and potentially recurrent pigmentation condition. Treatment focuses on reducing visible pigmentation while also managing the factors that may contribute to recurrence.
Learn more about pigmentation treatment in Singapore →
What Causes Melasma?
Melasma develops when melanocytes – the cells responsible for producing melanin – become more active and produce increased pigment within the skin.
Several factors may contribute. Hormonal changes are strongly associated with melasma, which helps explain why the condition may develop or worsen during pregnancy or with certain hormonal medications. Sun exposure is another major trigger. Ultraviolet radiation stimulates pigment production and can darken existing melasma.
Heat and visible light may also contribute in susceptible individuals, which is one reason melasma can sometimes remain difficult to control even with regular sunscreen use. Genetics also play a role. Patients with a family history of melasma may have a greater tendency to develop the condition. Because these factors often overlap, melasma usually requires a broader management strategy rather than treatment aimed only at existing pigment.
What Does Melasma Look Like?
Melasma commonly appears as irregular brown or grey-brown patches that are often distributed symmetrically across the face. Common areas include the cheeks, forehead, bridge of the nose, upper lip and chin.
It can sometimes be mistaken for other pigmentation conditions such as sunspots, Hori’s Naevus or post-inflammatory hyperpigmentation. Correct diagnosis is therefore important before treatment begins.
Learn more about the different forms of pigmentation treatment in Singapore →
Different Types of Melasma
Melasma has traditionally been described according to the apparent depth of pigment within the skin.
EPIDERMAL MELASMA In epidermal melasma, pigmentation is concentrated closer to the surface of the skin. It may appear darker brown and may respond more readily to selected topical therapies and pigment-targeting treatments.
DERMAL MELASMA Dermal pigmentation is located deeper within the skin and may have a lighter brown, grey or bluish appearance. Because the pigment is deeper, improvement may be slower and less predictable.
MIXED MELASMA Many patients have both superficial and deeper pigment. Mixed melasma is common and may require a combination approach because treatment directed at only one depth may not adequately address the entire condition.
In practice, melasma can be more complex than these categories alone suggest. Factors such as inflammation, vascular changes and skin barrier health may also influence how the condition behaves.
Can Melasma Be Completely Removed?
This is one of the most important misconceptions about melasma.
Melasma can often be improved, but it has a tendency to recur. Treatment may reduce existing pigmentation, but it does not permanently remove the skin’s ability to produce new melanin.
If triggering factors remain – such as ultraviolet exposure, hormonal influences, heat or inflammation -pigmentation may gradually return. For this reason, the aim of treatment is usually to reduce visible pigmentation, achieve a more even skin tone, minimise factors that aggravate melasma and maintain improvement over time. Patients should therefore think of melasma as a condition that often requires management rather than a one-time cure.
Melasma Treatment Options in Singapore
There is no single treatment that is appropriate for every patient with melasma. The treatment plan depends on factors such as pigment depth, skin type, previous treatments, skin sensitivity, medical history and the tendency for pigmentation to recur. A combination approach is often used.
PICO LASER FOR MELASMA Picosecond lasers deliver very short pulses of laser energy that can target selected pigmentation. In appropriately selected patients, Pico laser may form part of a melasma treatment plan. However, melasma should not be treated in the same way as an isolated sunspot. Aggressive pigment treatment may sometimes trigger inflammation and worsen pigmentation in susceptible individuals. Treatment settings therefore need to be selected carefully.
Learn more about Pico laser treatment →
PULSED RF MICRONEEDLING FOR MELASMA Radiofrequency microneedling may also be considered for selected patients with melasma. Unlike pigment-targeting lasers, RF microneedling works through controlled delivery of radiofrequency energy into the skin rather than directly targeting melanin. Certain pulsed RF systems have been used as part of treatment strategies for melasma, particularly where vascular or inflammatory components may be relevant. This does not mean RF microneedling is automatically suitable for every patient with melasma.
Learn more about pulsed RF microneedling for melasma →
MEDICAL SKINCARE Skincare is an important part of melasma management. Depending on the patient’s skin and medical history, treatment may involve ingredients intended to reduce pigment production, support skin turnover or improve skin barrier function. These may include topical agents such as hydroquinone, azelaic acid, retinoids, tranexamic acid, cysteamine or other pigment-modulating ingredients where appropriate. Because melasma-prone skin can also be sensitive, introducing too many active ingredients at once may cause irritation and potentially worsen pigmentation.
CHEMICAL PEELS Chemical peels may be considered for selected patients, particularly where superficial pigmentation is present. The type and strength of peel should be selected according to skin type and melasma characteristics. Peels should not simply be performed more aggressively in an attempt to remove pigment faster, as excessive inflammation may potentially worsen pigmentation.
ORAL MEDICATION Oral tranexamic acid may sometimes be considered for selected patients with melasma. It is not suitable for everyone and requires medical assessment because individual medical history and risk factors need to be considered before treatment.
Why Melasma Can Return After Treatment
It is common for patients to experience improvement and then notice pigmentation gradually returning. This does not necessarily mean the treatment “failed.”
Melasma is influenced by ongoing biological and environmental factors. Even when existing pigment has improved, melanocytes can remain responsive to triggers. Recurrence may be influenced by sun exposure, hormonal changes, heat, visible light, inflammation and inadequate maintenance. This is why maintenance treatment and prevention are often an important part of managing melasma.
Does Exfoliation Lighten Melasma?
Exfoliation can remove surface dead skin cells and may temporarily make the complexion appear brighter.
However, exfoliation alone does not address the underlying pigment activity responsible for melasma. Over-exfoliating can also impair the skin barrier and increase inflammation, potentially making pigmentation more difficult to manage. Patients with melasma therefore do not necessarily benefit from stronger or more frequent exfoliation. Sometimes, treating the skin more gently is the better approach.
Is Laser Always the Best Treatment for Melasma?
No. Laser treatment can be helpful for selected patients, but more treatment is not necessarily better. Melasma-prone skin may respond poorly to excessive heat or inflammation. Treatment should therefore focus on controlling the condition rather than repeatedly trying to destroy visible pigment. Some patients may benefit from a combination of laser or energy-based treatment, medical skincare, sun protection and maintenance.
Others may initially benefit more from improving skin barrier health and controlling triggers before additional procedures are introduced.
Why Sun Protection Matters in Melasma
Sun protection is one of the most important parts of melasma management. Ultraviolet radiation stimulates melanocytes and can cause existing pigmentation to darken.
Daily broad-spectrum sunscreen should therefore form part of the routine even when active treatment is not being performed. For patients susceptible to melasma, additional measures such as seeking shade, wearing a hat and limiting unnecessary prolonged sun exposure may also help. Tinted sunscreen containing iron oxides may provide additional protection against visible light for suitable patients.
Can Heat Make Melasma Worse?
Heat may contribute to melasma in some susceptible individuals. Patients who notice that their pigmentation worsens with heat may consider reducing unnecessary prolonged exposure to environments such as saunas, steam rooms or very hot exercise conditions. This does not mean that every patient with melasma must avoid heat completely.
The aim is to identify personal triggers and manage them where practical.
Melasma During and After Pregnancy
Melasma is sometimes called the “mask of pregnancy” because hormonal changes during pregnancy may stimulate pigmentation.
In some women, pregnancy-related pigmentation improves gradually after delivery. In others, melasma may persist.
Treatment options during pregnancy are more limited, and many elective aesthetic procedures are postponed. After pregnancy, treatment timing also depends on factors such as breastfeeding, the patient’s skin condition and the treatment being considered.
Learn more about postpartum care →
Melasma Is Not the Same as Every Other Pigmentation
One of the most important parts of treating melasma is making sure the condition has been correctly identified.
Sunspots, freckles, post-inflammatory pigmentation, Hori’s Naevus and melasma may all appear as brown pigmentation, but they behave differently. For example, an isolated superficial sunspot may respond well to a pigment-targeting laser. Melasma, by contrast, generally requires a more conservative and long-term approach. This is why using the same laser protocol for every form of pigmentation may produce disappointing results.
How Long Does Melasma Treatment Take?
There is no universal timeline.
Some patients notice improvement over several treatment sessions, while others require a longer period of management. The response depends on factors such as pigment depth, severity, treatment method, hormonal influences, sun exposure and individual skin behaviour. It is generally more useful to assess progress over time rather than expect complete clearance after a single treatment.
How Many Melasma Treatments Will I Need?
The number of treatments varies according to the individual. Some patients may undergo a series of laser or energy-based treatments followed by maintenance.
Others may require predominantly skincare or medication initially. Treatment should be adjusted according to response rather than following exactly the same schedule for everyone.
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