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Melasma
Symmetrical dark patches on the face: why they return and what brings them back.
Melasma is recognised by its shape before its colour: brown patches with blurred edges, arranged symmetrically on the two halves of the face — cheekbones, forehead, upper lip, sometimes the chin. It is this symmetry that distinguishes it from an isolated sun spot, which appears where the sun has struck most without following any pattern.
Underlying it is a combination of factors acting together: individual predisposition, a hormonal stimulus — pregnancy, contraceptives, hormone therapy — and the sun, which is the trigger that makes everything else visible. This is why it typically appears in women of childbearing age and why in pregnancy it takes the common name of "pregnancy mask".
What makes melasma frustrating is recurrence. It is not a spot that is removed and done with: it is a tendency of the skin to produce pigment in those areas when stimulated. Treatment can lighten it considerably, but if the stimulus remains — and the sun always remains — the pigment returns. Anyone promising to eliminate it definitively is describing something this condition does not do.
Hence the most important practical consequence, and the one patients most underestimate: sun protection is not an accessory to treatment, it is the treatment. A lightening course without serious daily protection, in winter too and in the city too, produces an improvement that is lost within a season.
Symmetry is the sign that sets it apart
A sun spot appears where the sun struck: isolated, irregular, with no counterpart on the other side of the face. Melasma does not — it draws mirrored patches on both cheekbones, or a band across the forehead, or a shadow above the lip. That symmetry is not chance: it says that underlying it is not only sun damage but also an internal stimulus, and it is why melasma is managed differently from an ordinary spot.
How it shows
- Brown or greyish-brown patches with blurred edges
- Symmetrical distribution over the two halves of the face
- Typical sites: cheekbones, forehead, upper lip, chin
- Appearing or worsening in pregnancy or with hormone therapy
- Marked worsening after sun exposure
- Fading in winter months and returning in spring
How we proceed
- 1Visit: assessment of distribution, colour and depth of the pigment
- 2Distinction from sun spots, post-inflammatory outcomes and other hyperpigmentation
- 3Review of hormonal factors and habitual sun exposure
- 4Definition of the lightening pathway suited to the case
- 5Daily sun protection and follow-up: the part that holds the result
Available treatments
- Dermatology visit
- Chemical peel
- Fractional laser
- Biostimulation
- Sun protection and maintenance
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Frequently asked questions
Will it go away after pregnancy?+
In some women, melasma that appeared during pregnancy fades progressively in the months after birth, and sometimes disappears. In others it persists, particularly if there has been sun exposure in the meantime. It cannot be predicted in advance: what can be done is to protect the skin from the outset, because sun in that phase is what makes the difference between a patch that fades and one that consolidates.
Is a lightening cream enough?+
It can be part of the pathway, but alone it is rarely enough and it is not risk-free: aggressive products, or products used long-term without supervision, can irritate the skin and cause inflammation which, paradoxically, produces more pigment. On melasma, aggressiveness is counterproductive more than elsewhere, and it is one reason to set it up with a physician.
Do I need protection in winter too?+
Yes, and it is the recommendation most often ignored. Melasma reacts to light even without full sun: cloudy days, reflections, the light of an ordinary day in the city. A well-run lightening course with protection used only in summer produces an improvement that is lost by the following spring.
Is laser always suitable?+
Not always, and on this condition it must be chosen with care. Melasma is skin that responds to stimulus by producing pigment: an overly energetic treatment can trigger exactly what one wants to reduce, with worsening rather than improvement. The choice of technique and intensity depends on phototype and pigment depth, and is made at the visit.
Related reading
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