Melasma and hyperpigmentation: causes and why it comes back

Melasma is a symmetrical, brownish-grey patch of pigmentation that appears on the face, usually on the cheeks, forehead and above the upper lip, when sun exposure, hormonal changes and a genetic tendency combine. Unlike ordinary sun spots, melasma covers larger areas and is likely to come back after treatment, because melanocytes (the cells that produce pigment) remain permanently more sensitive. Melasma is more common in women of reproductive age and in people with a naturally darker skin tone, but it can also occur in men, especially those who work outdoors a lot.

What is melasma and how does it differ from other types of pigmentation?

Melasma is a build-up of excess pigment that can sit in the upper layer of the skin (epidermal type), in a deeper layer (dermal type), or sometimes in both layers at once (mixed type). The difference between these three subtypes is not always visible to the eye, so an accurate assessment needs a dermatological exam. Unlike age-related sun spots (lentigines), melasma usually sits symmetrically on both sides of the face, and its edges are less defined. This difference directly affects the choice of treatment, since the dermal type is harder to treat than the epidermal type. To pinpoint the type, dermatologists sometimes use a special light source, such as a Wood's lamp, which shows more clearly which layer of skin the pigment sits in.

Why does melasma happen?

Several main factors play a role in the development of melasma:

• Sunlight (UV rays and even visible light) stimulates melanocytes
• Hormonal changes — pregnancy, hormonal contraception and hormone replacement therapy
• Genetic tendency — the risk is higher for those with a family history
• Heat and certain cosmetic products can also strengthen the effect of hormonal and sun-related factors

The form that appears during pregnancy is sometimes called the "mask of pregnancy," and it can partially fade after delivery as hormone levels return to normal, though it does not always disappear completely. In some cases, melasma is linked to changes in thyroid function, so a general health check can also be useful in persistent cases.

Why does melasma keep coming back?

Melasma is considered not fully "curable" but rather a condition that is kept under control. The reason is that once melanocytes have become sensitized, they can reactivate again from even minimal sun exposure, heat, or hormonal change. In particular, if sun protection is not kept up after treatment stops, the pigmentation can return within a few weeks. This is why dermatologists consider "managing" melasma a more accurate term than "eliminating" it completely. Seasonality also plays a role: melasma can become more visible in summer as sun intensity rises, and relatively fade in autumn and winter.

What treatment options are there?

Treatment is usually done in stages and chosen based on the individual case:

• Prescription topical cream (ingredients such as hydroquinone, azelaic acid, tranexamic acid) — to be used only as prescribed by a doctor
• A superficial chemical peel can add benefit in some cases, but a deep peel can make melasma worse
• Laser and IPL treatments must be carefully chosen by an experienced specialist, since they can worsen pigmentation if not done correctly
• Consistent daily use of a broad-spectrum sunscreen is the foundation of the whole treatment plan

Results usually appear gradually and require a few weeks of patience; changing or stopping treatment too early can make the process start over. In many cases the best result comes from combining different methods, but only a dermatologist should decide on that combination.

The biggest mistake in melasma treatment is stopping sun protection as soon as a result appears — this leads to pigmentation coming back quickly.

Why is sun protection at the center of treatment?

Whatever treatment method is used, managing melasma without daily sunscreen is nearly impossible. The article choosing sunscreen explains in detail what SPF and UVA/PA ratings mean, and why mineral filters are preferred for melasma. For skincare suited to Azerbaijan's climate, see skincare in Azerbaijan's climate. Tinted mineral sunscreens containing iron oxide are especially useful for melasma patients, because ordinary mineral filters protect against UV rays but do not give the same level of protection against visible light, and iron oxide fills that gap.

When to see a doctor

Melasma itself is not considered dangerous, but some signs can hide a different, more serious skin problem. It is worth seeing a dermatologist in the following cases:

• If the pigmentation is expanding quickly or getting darker
• If home remedies show no result over several months
• If the patch has an asymmetric shape, or you notice bleeding or crusting
• If strong irritation appears on the skin after a prescription cream

Frequently asked questions

Can melasma be completely cured?

Melasma is better thought of as a condition kept under control rather than one that fully disappears. With the right treatment and consistent sun protection, its appearance can improve significantly, but a complete and permanent result cannot be guaranteed. For most patients, the goal is not to make the pigmentation invisible, but to bring it down to a level that does not cause daily discomfort.

What sunscreen works best for melasma?

Mineral, broad-spectrum sunscreens with a high SPF are usually preferred, because mineral filters also give some protection against visible light. Tinted formulas containing iron oxide boost this protection even further. You can find more on this in the article about choosing sunscreen.

Is laser treatment safe for melasma?

Laser can benefit some patients, but poorly chosen settings can make pigmentation worse. This is why laser should only be used for melasma by an experienced specialist and with caution. Watching the reaction on a small test area before the procedure sometimes adds extra safety.

Does melasma go away on its own after pregnancy?

In some patients, pigmentation partially fades as hormone levels return to normal, but this does not always happen completely. In persistent cases, a dermatological evaluation is recommended. The chance of the same pigmentation recurring in later pregnancies should also be kept in mind, so paying attention to sun protection early on is useful. You can book a dermatology consultation through Dr Plasty.

This article is for information only and does not replace a medical consultation.