Melasma Treatment

Struggling with blotchy, brownish pigmentation that affects your confidence? Melasma is a common skin disorder that creates uneven patches on the face, and at Domain Dermatology, we specialise in diagnosing and treating melasma through our convenient telehealth services for patients across metropolitan and rural Australia.

What is Melasma?

Melasma is a common skin condition that causes uneven, brown to grey-brown patches on the face—most often on the forehead, cheeks, and upper lip. It tends to develop gradually and is particularly common in women, especially during periods of hormonal change such as pregnancy or while taking hormonal contraceptives. The pigmentation can vary in intensity and shape but typically has a symmetrical, blotchy appearance. While melasma is harmless, it can be persistent and cosmetically distressing, often requiring a long-term management approach.

Who Gets Melasma?

Melasma is more prevalent in women than in men, typically emerging between the ages of 20 and 40. It is especially common in individuals who tan easily or who have naturally brown skin (Fitzpatrick skin phototypes III and IV), while being less common in those with very fair or very dark skin tones.

What Causes Melasma?

The exact cause of melasma is complex and multifactorial. It is thought to be a form of photoageing in genetically predisposed individuals. Key contributing factors include:

Sun Exposure: Ultraviolet (UV) and visible light stimulate melanocytes (pigment cells) to produce more melanin.
Hormonal Changes: Pregnancy and the use of oestrogen/progesterone-containing therapies, including some contraceptives and hormone replacement treatments, are common triggers.
Genetics: A family history of melasma is reported in approximately 60% of cases.
Medications & Products: Certain targeted cancer therapies, perfumed soaps, and cosmetic products may cause phototoxic reactions.
Additional Factors: Researchers are exploring the roles of stem cells, vascular factors, and local hormonal influences in melanocyte activation.

What are the Clinical Features of Melasma?

Melasma appears as symmetrical, patches on the face. There are no symptoms before or after the patches develop. Distinct patterns include:

Centrofacial: Involves the forehead, cheeks, nose, and upper lip, sparing the philtrum.
Malar: Localised on the cheeks and nose.
Mandibular: Affects the jawline and chin.
Extrafacial: In rarer cases, it may affect sun-exposed areas such as the forearms or shoulders.

Melasma can be classified based on the depth of pigment deposition:

Epidermal Melasma: Typically dark brown with well-defined borders, accentuated under Wood’s lamp examination, and usually responds well to treatment.
Dermal Melasma: Appears as light brown to blue-grey patches with ill-defined borders and a poorer response to treatment.
Mixed Melasma: Features combined characteristics and often shows only partial improvement with therapy.

How is Melasma Diagnosed?

Melasma is primarily diagnosed by examining the distribution and appearance of pigmentation on the face. The diagnosis is most often clinical, meaning that no special tests are required to make the diagnosis.

If uncertain, dermatologists may use:

Wood’s Lamp Examination: Helps identify whether the pigmentation is primarily epidermal or dermal.
Dermatoscopy: Provides a closer view of pigmentation patterns.
Skin Biopsy: Occasionally performed to rule out other conditions, though it is not usually necessary.

How is Melasma Treated?

Managing melasma typically involves a combination of general measures, topical therapies, oral treatments, and procedural techniques.

General Measures

Sun Protection: Year-round, comprehensive sun protection is critical. This includes wearing a broad-brimmed hat and applying a broad-spectrum sunscreen with SPF 50+ containing zinc oxide, titanium dioxide, and iron oxides.
Avoidance of Triggers: Discontinuing hormone-containing contraceptives when possible and adopting photoprotective behaviours.
Cosmetic Camouflage: Using makeup specifically formulated to neutralise uneven skin tone.

Topical Therapy

For many patients, the foundation of melasma treatment is a topical regimen that may include:

Skin Lightening Agents: Hydroquinone remains a mainstay for reducing melanin production.
Retinoids: Such as tretinoin, which help to increase cell turnover and enhance the penetration of other agents.
Anti-Inflammatory Agents: A mild corticosteroid is often included in combination treatments to reduce irritation.
Other Actives: Ingredients like azelaic acid, kojic acid, cysteamine, and vitamin C (ascorbic acid) may also be incorporated, either alone or in combination.

The most effective formulation often reported is a triple combination cream (consisting of a skin lightening agent, a retinoid, and a corticosteroid) which can clear or improve pigmentation in up to 60–80% of cases.

Oral Treatment

For some patients, especially those with more extensive or resistant melasma, oral treatments are often used to inhibit pathways involved in pigment production.

Procedural Techniques

For treatment-resistant cases, dermatologists might consider procedures such as:

Chemical Peels: Using alpha- or beta-hydroxy acids (e.g., glycolic or salicylic acid) to remove superficial pigment.
Laser and Light-Based Treatments: Options like Q-switched Nd:YAG or fractional lasers may be considered with caution due to the risk of post-inflammatory hyperpigmentation.
Microneedling: Which can help improve skin tone and enhance the effects of topical therapies.

Each treatment plan is tailored to your skin type, the depth of your melasma, and your individual triggers.

What is the Outcome for Melasma?

Melasma is a chronic condition that may improve with treatment but often requires ongoing management. Even with successful therapy, pigmentation may recur—especially with sun exposure. A realistic treatment plan involves long-term sun protection and regular follow-up care. Your dermatologist will work closely with you to set achievable goals and adjust your treatment as needed.

At Domain Dermatology, our expert team utilises the latest treatments and telehealth technology to help you manage melasma effectively—no matter where you are in Australia. Book your online consultation today for a personalised treatment plan and regain your natural, even skin tone.