By Dr Khushboo Sethia · Dermatologist, SkinWise Clinic Published Last reviewed
Melasma: when pigmentation tells a deeper story
It starts as a faint patch. A shadow across the cheeks or forehead. Over time, the shadow deepens — into a brown or grey-brown patch that makeup barely hides, and that returns every summer no matter how careful you’ve been with sunscreen.
This is melasma — one of the most common pigmentation disorders in Indian skin, and one of the most frequently misunderstood. It isn’t a tan. It isn’t lazy skincare. And it can’t be scrubbed or peeled away in a single session.
Melasma is a long, patient story your skin is telling. Here’s how we read it at SkinWise.
What melasma actually is
Melasma is a chronic pigmentation disorder where melanocytes (the pigment-producing cells in your skin) become overactive in specific areas, producing more melanin than the surrounding skin. The result is symmetrical patches of brown, tan or grey-brown pigment, most commonly on:
- The cheeks (the “malar” pattern)
- The forehead and bridge of the nose (the “centrofacial” pattern, the most common)
- The upper lip
- The chin and jawline
- Occasionally the forearms and neck
It is not a tan, and it doesn’t fade with sunscreen alone. It’s a chronic condition that needs ongoing, careful management — and almost everything you do to your skin affects it, for better or worse.
Why Indian skin is more prone
Three reasons.
Melanin density. Indian skin (Fitzpatrick III–V) has more melanocyte activity at baseline. When something triggers further activation — UV, heat, hormones, friction — the response is stronger and longer-lasting than in lighter skin.
Tropical climate. India sees high UV year-round. The same level of sun exposure that causes a temporary tan in someone living in colder climates causes accumulating pigmentation in Indian skin.
Hormonal exposure patterns. Pregnancy-induced melasma (often called chloasma or “the mask of pregnancy”) is extremely common in India, with rates of 50–70% in some studies. Hormonal contraception and HRT are additional triggers in adult women.
A 35-year-old Indian woman with a family history, two pregnancies, occasional birth control use and a 10-year history of daily commute on a two-wheeler is essentially the textbook melasma patient. She isn’t doing anything wrong; her skin is doing what melanin-rich skin does.
The three types — and why they need different plans
Melasma is usually classified by how deep the pigment sits:
Epidermal melasma — pigment in the upper layers of skin. Looks brown, well-defined edges. Most responsive to topical treatment and chemical peels. The most common type.
Dermal melasma — pigment deeper in the dermis. Looks blue-grey or slate-coloured, less defined edges. More resistant to topical-only treatment; sometimes responds to specialty lasers.
Mixed melasma — features of both. Most common in adult Indian women. Needs a layered plan combining topicals, sun protection, sometimes oral therapy, and only carefully chosen procedures.
Telling them apart on examination changes the entire treatment direction. Confusing dermal melasma for epidermal melasma is the most common reason an aggressive bleaching cream “doesn’t work” — or worse, makes things worse by darkening the surrounding skin.
What causes melasma to flare
Melasma is multifactorial. The most consistent triggers we see in our patients:
- UV exposure — the single biggest trigger. Even indirect sunlight through windows, indoor lighting (less significant), and reflected light from screens (negligible but often blamed)
- Visible light and heat — newer evidence shows visible light worsens melasma in melanin-rich skin (which is why tinted sunscreens with iron oxides outperform clear sunscreens for melasma patients)
- Hormones — pregnancy, contraceptive pills, hormone therapy, perimenopause shifts
- Genetics — runs in families; first-degree relatives have 30–40% risk
- Photosensitising medications — some antibiotics (doxycycline), some anti-epileptics, some retinoids paradoxically
- Cosmetic irritation — harsh actives, over-exfoliation, aggressive at-home peels
- Subclinical inflammation — anything that inflames the skin can leave residual pigmentation that looks melasma-like (this is post-inflammatory hyperpigmentation, often confused with melasma)
The trigger profile matters because the treatment depends on it. Pregnancy-related melasma treated with hydroquinone during pregnancy is a clear no. Sun-driven melasma in a patient who refuses to wear sunscreen will plateau regardless of how many peels we add.
Our approach to melasma at SkinWise
1. Identify the type and stage
A close skin examination, sometimes a Wood’s lamp to differentiate epidermal from dermal, history mapping the triggers, and photographs at the worst point in the cycle (which patients often remember to bring after we’ve asked at the first consult).
2. Make sun protection truly non-negotiable
Strict daily sunscreen is half of the treatment. We don’t mean “if you remember,” we mean every day, applied properly (two finger-lengths for face and neck), reapplied through the day, and combined with a tinted iron-oxide-containing formulation for melasma patients specifically.
If sun protection isn’t in place, no topical or procedural treatment delivers lasting results. Patients who come in for laser sessions but won’t wear sunscreen are politely told to start with the sunscreen first.
(For the full guide, see our sunscreen guide for Indian skin.)
3. Build a topical foundation
The melasma topical regimen is the workhorse. Depending on the patient and the stage:
- Hydroquinone, cycled (3–4 months on, 1–2 months off), as the gold-standard tyrosinase inhibitor. Stopped during pregnancy.
- Azelaic acid — gentler, safe during pregnancy, good for sensitive skin
- Kojic acid, arbutin, vitamin C, niacinamide — supporting ingredients in serums and morning routines
- Tranexamic acid topical — newer evidence supports its use; we sometimes pair with hydroquinone or use as an alternative
- Retinoids — accelerate cell turnover; introduced cautiously, only after the barrier is stable
This regimen takes 6–8 weeks to start showing visible change, and 3–6 months to reach a meaningful plateau. We tell every patient this upfront so they don’t give up at week 3.
4. Add oral therapy when indicated
For moderate-to-severe melasma or melasma resistant to topicals alone:
- Oral tranexamic acid — strong evidence for melasma; we use it in carefully selected patients with full medical workup (it’s not appropriate for everyone, particularly patients with clotting risk factors)
- Polypodium leucotomos extract — oral photoprotection adjunct
- Antioxidant supplementation — supportive
We never start oral tranexamic acid casually. It’s a prescription, monitored, with clear indications.
5. In-clinic procedures, conservatively
This is where melasma treatment most often goes wrong in less-experienced hands. Aggressive procedures can rebound melasma to a darker state than the starting point.
What we do:
- Gentle chemical peels — mandelic, lactic, glycolic at conservative concentrations. Usually 4–6 sessions, 3–4 weeks apart. (Glycolic vs mandelic for Indian skin →)
- Microneedling with tranexamic acid — emerging protocol, well-tolerated, useful when topicals plateau
- Low-fluence Q-switched or pico laser — only after topicals have stabilised the skin and only on selected patients. Carries real risk on melanin-rich skin if settings aren’t conservative.
What we generally don’t do for melasma:
- High-intensity laser without preparation
- Aggressive cryotherapy
- “DIY laser” home devices
- Random over-the-counter “whitening” products with unregulated active ingredients
6. Move to maintenance
Once melasma is well-controlled, we move to a maintenance phase: low-frequency topical use, daily sunscreen, periodic check-ins. Most patients stay on some form of management long-term because melasma is genuinely chronic — but the maintenance is much lighter than the active treatment phase.
What patients can expect at each stage
Day 1: Strict sunscreen starts immediately. This is not optional.
Weeks 6–8: First visible effect of topicals. Skin looks calmer, marginally lighter. Most patients are tempted to give up around week 4 — don’t.
3 months: Meaningful lightening. Patients usually feel the difference; family members notice.
6 months: Plateau on topicals alone for many patients. This is when we add (or escalate) peels, oral therapy, or laser if appropriate.
12 months: Best-case results are achieved in this window. Skin tone has settled into a manageable baseline. Move to maintenance.
Long-term: Periodic flares with seasons or pregnancy are normal and manageable with a known plan. Most patients stay on minimal maintenance forever.
What NOT to do
The most common reasons melasma gets worse:
- Skipping sunscreen because “it’s overcast” or “I’m mostly indoors” — UVA passes through windows; cloud cover blocks only 20% of UV
- Over-exfoliating — strong scrubs and acids inflame the skin and worsen pigmentation
- Trying every product you see on social media — melasma plans need consistency, not novelty
- Stopping treatment when you see improvement — the gain doesn’t hold without sustained topical / sunscreen use
- Going to a clinic that uses the same laser on every patient regardless of skin tone — see our post on diode vs Nd:YAG laser for Indian skin
- Self-treating during pregnancy — most prescription melasma topicals are off-limits during pregnancy; we have a separate gentler plan for pregnancy
Frequently asked questions
Can melasma be permanently cured? Honest answer: no. It’s a chronic condition that can be well-managed — sometimes for years at a time — but the underlying tendency remains. Many patients reach a maintenance state where melasma is barely visible and stable.
I’m pregnant and my melasma is worse. What can I safely do? Strict sun protection (tinted mineral sunscreen, SPF 50, reapplied), azelaic acid, gentle vitamin C, and barrier care. No retinoids, no hydroquinone, no oral therapy during pregnancy. Post-delivery, we restart the full regimen.
Will my melasma fade after pregnancy? Sometimes, partially, over 6–12 months. Often it doesn’t fully resolve and benefits from active treatment once breastfeeding is complete.
Are home laser devices safe for melasma? We don’t recommend them. The settings on consumer devices aren’t calibrated for melanin-rich skin and can worsen pigmentation. In-clinic laser is a careful, individualised intervention.
My friend got dramatic results from “laser whitening” in 2 sessions. Should I try it? Probably not. Dramatic short-term lightening on melasma usually means the laser was set aggressively, and rebound darkening is common within months. Sustainable melasma management is slow and steady, not dramatic.
Why does my melasma get worse in summer / monsoon? Summer: more UV and more visible light. Monsoon: more humidity, more heat, and many patients reduce sunscreen frequency assuming overcast equals safe. It isn’t.
Should I cover up completely outdoors? Hats, umbrellas and physical shading are excellent adjuncts to sunscreen. We particularly recommend them for high-UV midday hours and during travel to coastal areas.
How does melasma differ from sun tan or freckles? Sun tans fade over weeks once exposure stops. Freckles are smaller, discrete, mostly genetic, and don’t change much with treatment. Melasma is symmetrical, patchy, persistent, hormonally influenced — and treatable, but with effort.
Where to go from here
A focused 15-minute dermatology consultation is the right first step. Bring photos of your skin at its worst (we often see patients at a calm moment), and any topical products you currently use.
If you’re already mid-journey and feeling stuck, come anyway — the most common stalled-melasma plan we revive is the one where topicals were started without enough sunscreen behind them.
Related reading: