Melasma rewards patience — and a plan that doesn’t overreach.
Melasma is the pigmentation that doesn’t respond to the bottle of cream a friend recommended. It sits on the cheeks, the forehead, the upper lip — symmetrical, hormone-sensitive, and quietly tied to UV, heat and the way Indian skin holds pigment.
On the surface it looks like “dark spots”. Under closer examination — Wood’s lamp, dermoscopy — it reveals itself as epidermal, dermal or mixed, and that distinction changes everything about what we should and shouldn’t do. Aggressive lasers on dermal melasma make it worse. Skipping sunscreen makes any treatment plateau.
This page is separate from our general pigmentation service for a reason: melasma is its own animal. The plan is longer, the discipline matters more, and the most important step is the one that costs the least — daily, well-applied sunscreen.
Wood’s lamp and dermoscopy at the first visit. The depth of pigment changes the prognosis honestly — epidermal melasma responds well to topicals and peels; dermal melasma is more stubborn and demands a slower hand.
UV is the loudest one, but heat, hormones and over-exfoliation matter just as much. Without removing the trigger, the brightest topical regimen plateaus within months.
Sunscreen daily (this is non-negotiable and half the treatment). Then tranexamic acid, azelaic acid and kojic acid as a baseline, with hydroquinone introduced in supervised cycles — never indefinitely. Oral tranexamic acid in carefully selected patients.
Mandelic and lactic peels first — small, low-strength, well-spaced. Q-switched Nd:YAG laser is added only after months of topical stabilisation, and only at conservative settings. We never lead with aggressive lasers on melasma.
Sunscreen daily and well-applied — this is half of the treatment, and where almost every stalled plan went wrong.
Topicals begin to show. Pigmentation looks calmer, less sharp around the edges.
Visible lightening. Most patients see the biggest shift between months 3 and 6.
Melasma is managed, not cured. We move to maintenance reviews every 8–12 weeks once the skin has settled.
| Melasma consultation (15 min, with Wood’s lamp / dermoscopy) | ₹1,000 |
|---|---|
| Prescription topical regimen | Quoted at consult |
| Mandelic / lactic peel (per session) | ₹3,000 – ₹6,000 |
| Q-switched Nd:YAG laser, small area (per session) | ₹4,000 – ₹8,000 |
| Maintenance review (every 8–12 weeks) | ₹1,000 |
Courses of 4–6 peels or laser sessions are planned 3–4 weeks apart and quoted together at consult. Most melasma plans run over 6–12 months.
Honestly — usually not. Melasma is managed rather than cured. With sun protection, the right topicals and the occasional carefully chosen procedure, most patients hold a quiet, even-toned baseline. Stopping the routine is the most common reason it returns.
No — and anyone promising that on Indian skin is overpromising. Lasers can help in the right patient and at the right time, but they can also worsen melasma when used too early or too aggressively. We laser only after months of topical stabilisation.
Yes. Strict sun protection, azelaic acid and gentle vitamin C are safe in pregnancy. We pause hydroquinone, retinoids and oral tranexamic acid until you’ve finished breastfeeding.
Both UV and heat drive pigment cells. For Bengaluru patients, a real sunscreen reapplied through the day — and avoiding direct heat at the stovetop where possible — often does more than a stronger night cream.
On Indian skin, yes — if the plan is too aggressive. That’s why we lead with topicals, use the gentlest peels first, and reserve Q-switched Nd:YAG for the right moment. Conservative wins on melasma.
The pigmentation service covers everything from PIH to dark circles to friction pigmentation. Melasma needs its own page because the diagnosis is specific, the timeline is longer, and the wrong move sets you back months.
Most plans at SkinWise begin with a focused 15-minute consultation. We map the concern, talk through what you’ve tried, and only then suggest what comes next — no oversell.