Understanding Melasma: Causes, Treatment, and Long-Term Outlook for UK Patients
- Zaynah Goyal
- Jun 26
- 4 min read
As summer arrives and the sun begins to shine more brightly across the UK, we often see a seasonal surge in skin conditions that are aggravated by UV exposure. One such condition is melasma, a common pigmentation disorder that causes significant cosmetic concern. At mySkinDoc, we frequently receive enquiries about this condition, especially as patients notice their pigmentation worsening in the sun.
This blog will explain what melasma is, its causes, how it can be managed, and what patients can expect in the long run.
What Is Melasma?
Melasma is a chronic skin condition that causes brown or grey-brown patches of pigmentation, typically on sun-exposed areas of the face such as the cheeks, forehead, nose, and upper lip. While it can affect anyone, melasma is more common in women, particularly those with darker skin types (Fitzpatrick III–VI) and those of Asian, Middle Eastern, Mediterranean, and Latin American descent.
Key features of melasma:
Symmetrical patches on both sides of the face
Irregular borders
No associated symptoms like itching or pain
Aggravated by sun exposure, hormonal changes, and certain medications
What Causes Melasma?
Melasma results from an overproduction of melanin, the pigment that gives skin its colour. This overproduction is triggered by a complex interplay of factors:
1. Sun Exposure
Ultraviolet (UV) light is one of the strongest triggers. UV rays stimulate melanocytes (pigment-producing cells) to produce excess melanin. Even brief sun exposure can worsen melasma or undo months of treatment progress.
2. Hormones
Melasma is strongly linked with hormonal changes. It often appears during pregnancy (also known as the “mask of pregnancy” or chloasma), while taking oral contraceptives, or during hormone replacement therapy.
3. Genetics
There is often a family history of melasma, suggesting a genetic predisposition.
4. Skincare Products
Certain cosmetics or irritants can cause inflammation that leads to post-inflammatory hyperpigmentation, mimicking or exacerbating melasma.
5. Medications
Photosensitising drugs—such as certain antibiotics and anti-seizure medications—can also contribute to pigmentation changes.
How Is Melasma Diagnosed?
Diagnosis is usually clinical, based on the appearance and pattern of pigmentation. In some cases, a Wood’s lamp (a special type of light) is used to determine how deeply the pigment is deposited in the skin:
Epidermal melasma: Pigment is superficial and responds better to treatment.
Dermal melasma: Pigment is deeper and harder to treat.
Mixed type: Combination of both.
A dermatologist may sometimes consider a skin biopsy if the diagnosis is unclear.
How Can Melasma Be Managed?
Melasma can be persistent and challenging, but with a consistent, tailored approach, many patients see improvement.
1. Sun Protection – The Cornerstone
Broad-spectrum SPF 50+ sunscreen, applied every morning and reapplied every 2 hours outdoors
Physical blockers containing zinc oxide or titanium dioxide
Wide-brimmed hats and avoiding midday sun
Even incidental sun exposure (e.g. through car windows) can aggravate melasma.
2. Topical Treatments
Dermatologists often prescribe skin-lightening agents to reduce melanin production:
Hydroquinone: A gold standard, used short-term to lighten pigmentation
Tretinoin: Promotes skin turnover
Corticosteroids: Reduce inflammation
Combination creams (e.g. Kligman’s formula): Hydroquinone + tretinoin + steroid
Over-the-counter alternatives include:
Azelaic acid
Kojic acid
Vitamin C serums
Niacinamide
Caution: Incorrect or unsupervised use of bleaching creams (especially ones bought online) can worsen melasma or damage the skin.
3. Chemical Peels
Mild chemical peels (like glycolic acid or salicylic acid peels) can help exfoliate the skin and improve superficial pigmentation. These are typically done in a clinic and spaced every few weeks.
4. Microneedling and Mesotherapy
These treatments can enhance the penetration of topical agents. Mesotherapy sometimes involves infusing tranexamic acid or other lightening agents into the skin.
5. Oral Medications
Tranexamic Acid (off-label): Originally used to treat bleeding, this medication has shown benefit in melasma, particularly in resistant cases. However, it must be prescribed carefully due to potential side effects like clotting risks.
6. Laser and Light-Based Therapies
Lasers (e.g. Q-switched Nd:YAG or fractional lasers) can improve pigmentation but carry the risk of rebound melasma and must be used cautiously, especially in darker skin types. They should only be performed by dermatologists with expertise in pigmentary disorders.
What Is the Long-Term Outlook?
Melasma is a chronic, relapsing condition. While it can be improved, there is currently no permanent cure. The key is to control and suppress pigment production rather than expecting full eradication.
With proper management:
Many patients experience significant lightening of pigmentation
Long periods of remission are possible
Relapses can occur—especially in the summer or with hormonal changes
Maintenance treatment is often necessary. Once pigmentation improves, continued use of sun protection and mild skin-brightening products can prevent recurrence.
Emotional and Psychological Impact
Melasma can have a profound effect on confidence and self-esteem, especially in visible areas like the face. At mySkinDoc, we approach this condition with empathy and long-term support, helping patients understand that melasma is common and manageable.
Frequently Asked Questions
Q: Can melasma go away on its own?
In some cases, melasma triggered by pregnancy or medications may fade after the trigger is removed. However, most cases persist and require treatment.
Q: Are natural remedies like lemon juice or turmeric helpful?
There is limited scientific evidence for these. In fact, many DIY treatments can cause skin irritation, making melasma worse.
Q: Is melasma dangerous?
No, melasma is harmless in a medical sense, but it can have emotional and psychological effects due to its appearance.
Q: Can men get melasma?
Yes, though it’s less common. Around 10% of melasma cases occur in men.
Final Thoughts from mySkinDoc
At mySkinDoc, we understand that melasma can be distressing—especially when it flares up during sunnier months. With expert advice, personalised treatment, and ongoing care, most patients can achieve a significant improvement in their skin.
If you’re struggling with melasma or want to discuss your skincare options, book an online consultation with our dermatology specialists today. We’re here to help you achieve clear, healthy, and confident skin—whatever the weather.
For more detailed information and guidance, visit mySkinDoc.
