Understanding Melasma: Why It Happens & What Actually Works

Those stubborn cheek patches aren't just tan. Here's what melasma really is, and the evidence-based protocols we use to treat it.

Melasma is one of the most frustrating skin conditions we treat. It looks like tan, behaves like tan, but no amount of staying indoors fully clears it. Understanding why is the first step to actually treating it.

What is melasma?

Melasma is a chronic disorder of pigment-producing cells (melanocytes) that overproduce melanin in response to UV light, visible light, heat, and hormonal triggers. It typically appears on the cheeks, forehead, upper lip and chin in symmetrical patches.

Who gets it

Women of reproductive age with skin types III–VI are most affected. Pregnancy, oral contraceptives, thyroid dysfunction and even cooking heat can trigger or worsen it.

What actually works

1. Strict photoprotection — broad-spectrum SPF 50+ with iron oxides for visible light, reapplied every 3 hours. This alone fades 30% of melasma.

2. Topical lightening — a tailored combination of hydroquinone, tranexamic acid, kojic acid or cysteamine, prescribed by a dermatologist.

3. Chemical peels — mandelic and lactic acid peels at controlled strengths, every 2–3 weeks.

4. Q-switched Nd:YAG laser toning — for resistant cases, at the right fluence to avoid rebound darkening.

What doesn't work

Lemon, turmeric, kitchen scrubs and aggressive bleaching creams. They thin the barrier, trigger inflammation, and make the pigment darker over time.

Melasma is a marathon, not a sprint. With a consistent regimen and SPF discipline, most patients see 70–80% improvement in 6 months.