Melasma treatment: what helps and what to expect

Managing melasma in layers

No single treatment works for everyone, and combinations give better results than any treatment alone ^[2]. Think of melasma care as layers that build on each other.

1. Daily sun protection, including visible light

This is the foundation, and without it nothing else holds. Standard broad-spectrum sunscreens protect against ultraviolet light but not adequately against visible light, which can also drive pigmentation ^[3]. To block visible light, a sunscreen has to be visible on the skin: that is what tinted mineral sunscreens do ^[3].

The difference shows. In a randomised trial of 68 people with melasma, all using a depigmenting cream, those who used a sunscreen that also blocked visible light had a 15% greater improvement in their severity score after eight weeks than those using UV-only sunscreen ^[4].

In practice, apply a tinted sunscreen every morning, all year, and reapply when you are outdoors. Add a hat and shade. Indoors near bright windows counts too.

2. Prescription depigmenting treatment

The second layer is a prescription depigmenting cream, chosen and supervised by a doctor. These creams reduce pigment production and help the skin shed what has already formed. They need correct strength, correct duration and breaks, because using them without supervision can irritate the skin and, through that irritation, make pigmentation worse.

In selected cases, a doctor may consider an oral treatment as well. That requires a full medical history and a check for reasons not to use it, and it is never a first step taken alone.

3. Superficial peels

Chemical peels can speed up improvement once the skin is protected and prepared. A systematic review of 24 studies including 1,075 patients found chemical peels safe and effective in melasma ^[5]. Superficial peels are preferred, because deeper ones inflame the skin and inflammation can trigger more pigment. We explain how peels work and what recovery is like in our guide to chemical peels.

4. Lasers and IPL, with great caution

Lasers and intense pulsed light are the layer that most needs care. A meta-analysis of 22 studies and 694 patients found that most lasers, often combined with other treatment, reduced melasma severity. Some types did not, and in darker skin there was a risk of patches becoming darker or lighter than the surrounding skin ^[6]. A meta-analysis of IPL used in combination with other treatment also found lower severity scores ^[7].

The problem is rebound. In a series of 116 people treated with a heat-generating laser for skin rejuvenation, 11% developed new or worse melasma, on average more than a year later ^[8]. That is why light-based treatment, if used at all, comes after diagnosis, with skin prepared, conservative settings and strict sun protection. Our article on IPL for sun spots and pigmentation explains how IPL is used for sun spots and other pigmentation.

5. Maintenance

Recurrence rates remain high with every treatment ^[2]. Once the patches have lightened, the goal is to keep them there: daily tinted sunscreen, a maintenance routine agreed with your doctor and extra care before and during summer.

What to expect, realistically

• Lighter, more even patches, not complete disappearance in every case.
• Gradual change over months, not weeks.
• Flare-ups with sun, heat or hormonal changes, which are easier to calm when you act early.
• Ongoing maintenance, especially if you live here all year.

Melasma is controlled, not cured. Anyone promising permanent removal in one session is not describing melasma.

Risks, and who should wait

Prescription creams can cause redness, dryness, stinging and irritation, which is why doses and timing are adjusted. Peels can cause redness, flaking and temporary sun sensitivity. Lasers and IPL can cause darker or lighter patches and, as above, trigger rebound.

Treatment is usually postponed during pregnancy and breastfeeding, on recently tanned skin, with active eczema or infection on the face, or if you cannot avoid strong sun in the weeks after a procedure. Planning a peel just before a beach holiday is not a good idea.

How we approach it at Rejuvelook

At our clinic in Fuengirola, a doctor sees you for a consultation and examines the pigmentation first. Confirming that it is melasma, and not something else, comes before any treatment. The doctor then builds a plan for your skin and your lifestyle, which may include sun protection, prescription treatment and selected in-clinic treatments such as superficial peels. If your pigmentation needs a dermatologist, we will refer you. We see patients in English or Spanish.

You can read more about our facial treatments and how we decide which one suits your skin.