Melasma: Why This Common Pigmentation Disorder Deserves Specialist Care

The spelling, terminology, and geography have been tailored for a UK audience (e.g., using photoageing, grey-brown, individualised, and organisations), while sharpening the focus on UK-specific advice (such as adjusting the location references and highlighting the UK's regulation around prescription-only ingredients like high-strength hydroquinone).

Melasma is one of the most misunderstood conditions we see across our UK clinics. It is frequently confused with photoageing or post-inflammatory hyperpigmentation, but melasma is a distinct diagnosis with its own triggers, its own risks, and its own treatment pathway. Getting that diagnosis right from the outset is the single most important step in managing it well — because the wrong treatment, chosen without specialist input, can make melasma considerably worse and, in some cases, cause changes to the skin that cannot be reversed.

What Melasma Actually Is

Melasma typically presents as symmetrical brown or grey-brown patches, most commonly across the cheeks, forehead, upper lip, and chin. It affects women far more often than men, although men are not immune. It can also appear outside the face — the forearms are a recognised site, particularly in post-menopausal women.

Several factors contribute to melasma, and it is rarely caused by just one thing. Pregnancy is a well-known trigger, which is why melasma is sometimes called the "mask of pregnancy", but genetics play a strong role too, and a family history is common. Heat exposure — not just UV light — can trigger and worsen melasma, and it is increasingly understood as part of the broader ageing process of the skin, alongside its links to photoageing.

Underneath the surface, the pigment in melasma sits in a mixed pattern — both epidermal and dermal — and this pigment is genuinely unstable. That instability is precisely why treatment has to be approached with caution and by someone who understands the condition, rather than treated as a quick cosmetic fix.

Why Diagnosis Comes First

Every melasma patient at ADC is first seen by one of our dermatology specialists or dermatologists, either in person or via a virtual consultation. During this assessment, we examine photographs, take a careful history, and work through possible risk factors with the patient so that, where possible, these can be reduced or removed. This step matters because melasma can look similar to other pigmentation conditions, and treating it as though it were photoageing or post-inflammatory hyperpigmentation can lead to the wrong approach entirely.

Photoprotection: The Non-Negotiable Foundation

Photoprotection is essential for every melasma patient, especially whenever the UV index rises above 3 — in the UK, this generally spans March through to September. We advise wide-brimmed hats, sunglasses, and a very high level of both UVA and UVB protection every single day.

For melasma specifically, we go a step further and recommend sunscreens containing iron oxide, which help block visible light — a trigger that standard UVA/UVB filters alone do not address. Patients also need to understand that melasma is, in part, a disorder of photoageing, which means a strict, consistent daily skincare regimen is essential, not optional.

A Bespoke Skincare Regimen

We build a bespoke REFORM Skincare regimen for every melasma patient. Depending on the individual, this typically includes:

• SPF 50+ with strong UVA and high-energy visible light (HEVL) filters

• 20% vitamin C serum

• High-percentage niacinamide

• Glycolic and mandelic acid exfoliants

• Tyrosinase inhibitors

• Retinol, provided the patient is not pregnant or breastfeeding

For patients who would prefer not to see a doctor initially, or where melasma appears very mild, the REFORM Skincare app offers a free skin analysis with printed, personalised daily skincare recommendations. A photo consultation with one of our doctors is also available where appropriate. There is a charge for any consultation with a dermatology specialist, but a virtual photo consultation is more accessible than an in-person visit and can be accessed from anywhere in the UK.

When Skincare Isn't Enough

If skincare alone doesn't achieve the desired result, our doctors can prescribe additional medical options, including oral tranexamic acid and prescription-strength hydroquinone, where clinically appropriate.

In-Clinic Treatment Options

We are cautious with any laser treatment for melasma because heat itself can act as a trigger. While we do offer Q-switched Nd:YAG laser treatment, it is not our first-line recommendation for melasma. Other in-clinic options we offer include:

• Medical microneedling

• TCA whitening peels

• Cosmelan-style peels (similar to Dermamelan), which can be both safe and effective when carefully managed

• Mesotherapy with tranexamic acid, which can also deliver excellent results

Chosen correctly, and combined with strict adherence to aftercare — proper skincare and daily photoprotection — in-clinic treatments can genuinely help. However, patients need to understand that melasma is a chronic, relapsing condition. Even with the best care, perfection isn't always achievable, and relapses are a real and, understandably, disappointing part of managing this condition long term.

Why Professional Advice Matters From the Start

Melasma is a condition where we would strongly urge patients to seek proper professional advice from day one. A significant amount of damage can be done by choosing inappropriate treatments such as IPL or certain lasers without specialist guidance, and this damage may not be reversible. Irritating skincare can make melasma worse rather than better, and lapses in proper sunscreen use can undo months of progress.

Unlike in the UK, where high-strength hydroquinone is strictly prescription-only, some overseas markets sell it over the counter. Prolonged, unsupervised use of hydroquinone at high concentrations can cause ochronosis — a permanent, disfiguring form of skin discolouration. This is exactly why starting correctly, maintaining correctly, and treating correctly matters so much with melasma.

Book a Consultation

Whether you are based in London or accessing us from anywhere else across the UK, our dermatology specialists are here to give melasma the careful, individualised approach it needs — from first diagnosis through to long-term management. Your skin will thank you.