Why is melasma so difficult to treat?
Updated: Oct 6
Melasma can be one of the more challenging forms of facial pigmentation to manage. While treatment can significantly improve the appearance of melasma, the underlying tendency to develop excess pigmentation can remain, meaning that pigmentation may return over time.
Melasma treatment therefore isn't simply about removing existing pigmentation. It involves identifying potential triggers, protecting the skin from UV and visible light, choosing appropriate skincare and, where appropriate, considering medical or procedural treatments.
1. Melasma can have multiple triggers
There is rarely a single cause that can simply be removed.
For example, someone may have a combination of:
Genetic susceptibility
Hormonal influences
UV exposure
Visible light exposure
Heat
Previous inflammation
This means that treating the pigmentation alone may not be enough.
These factors don't affect everyone in the same way, and melasma often develops through a combination of influences rather than a single identifiable cause. This is one reason why there is no universal melasma treatment that works equally well for everyone.
2. It can come back
One of the biggest challenges with melasma is recurrence.
Even when treatment successfully reduces visible pigmentation, the underlying tendency to develop melasma can remain. This means that maintenance skincare and consistent protection from UV and visible light may be important even after the pigmentation has improved.
3. Treatment can sometimes irritate the skin
It can be tempting to use increasingly strong products or multiple active ingredients in an attempt to achieve faster results.
However, excessive irritation can damage the skin barrier and cause inflammation. In susceptible individuals, inflammation can contribute to further pigmentation.
The aim should therefore not simply be to use the strongest possible treatment.
A carefully introduced and supervised routine may be more appropriate.
4. Melasma is not always superficial
Melanin can be located at different levels within the skin. Some pigmentation is predominantly epidermal, while other melanin may extend deeper into the skin.
Deeper pigmentation can be more difficult to improve and may respond less predictably to topical treatments.
This is one reason why two people with apparently similar pigmentation may have very different treatment responses.
How is melasma treated?
There is no single treatment that works for everyone with melasma.
Management generally involves a combination of sun and light protection, appropriate skincare and, in selected cases, medical or procedural treatments.
The most appropriate approach depends on the individual's skin type, pigmentation, sensitivity and medical history.
1. Sun and Visible Light Protection
Sun protection is one of the most important parts of managing melasma.
A broad-spectrum sunscreen should be used consistently, alongside practical measures such as:
Seeking shade
Wearing a wide-brimmed hat
Avoiding prolonged exposure to strong sunlight
Taking particular care during holidays and outdoor activities
For people prone to melasma, consistent protection is important not only during treatment but also afterwards.
Because visible light can contribute to pigmentation in some individuals, a tinted sunscreen containing iron oxides may be worth considering.
2. Medical skincare
Medical skincare can form an important part of a melasma treatment programme.
Obagi Medical offers a range of skincare products and structured programmes designed to address concerns including uneven skin tone, pigmentation and photodamage.
Depending on the individual's skin and the nature of their pigmentation, a skincare programme may incorporate ingredients such as:
Vitamin C
Vitamin C, particularly L-ascorbic acid, is an antioxidant that can help protect the skin from oxidative stress and may contribute to a more even complexion.
Retinoids and retinol
Vitamin A derivatives can influence epidermal turnover and are used in dermatology as part of approaches to pigmentation and photoageing.
Some retinoids are prescription-only medicines and require appropriate medical assessment and prescribing.
Arbutin
Arbutin is a pigment-modulating ingredient found in some skincare formulations. It can be incorporated into routines designed to address uneven pigmentation.
Hydroquinone
Hydroquinone is a potent pigment-modulating medicine that has historically been used in the management of melasma and other forms of hyperpigmentation.
Some Obagi formulations containing hydroquinone are prescription products. These should only be considered following an appropriate medical assessment and prescription where clinically indicated.
More is not necessarily better. Introducing too many active ingredients or using them too aggressively can cause irritation, potentially making pigmentation more difficult to manage.
How Obagi Skincare Can Support Melasma Treatment
A major advantage of a medical skincare approach is that treatment can be structured around the individual rather than simply selecting a single "pigmentation cream".
With Obagi Medical®, different products and programmes can be used according to the individual's skin concerns, tolerance and treatment goals.
For someone with melasma, the approach may involve:
Assessing the type and distribution of pigmentation
Establishing an appropriate skincare routine
Introducing active ingredients gradually
Supporting the skin barrier
Maintaining consistent sun protection
Reviewing progress and adjusting treatment where necessary
Developing a maintenance programme once pigmentation has improved
This structured approach is particularly relevant to melasma because treatment is often a long-term process rather than a short course of treatment.
Can chemical peels treat melasma?
Chemical peels may be considered for selected patients.
They work by producing controlled exfoliation of the skin and can potentially improve pigmentation and skin texture.
However, melasma requires particular care when considering procedures.
If the skin becomes significantly inflamed following treatment, this may potentially worsen pigmentation, particularly in individuals prone to post-inflammatory hyperpigmentation.
For this reason, the decision to use a chemical peel should take into account:
Skin type
Previous history of pigmentation
Current skincare
Sensitivity
Type and depth of pigmentation
Previous treatments
A more aggressive treatment is not necessarily a more effective treatment.
Can Laser Treatment Improve Melasma?
Laser and light-based treatments may have a role in selected cases, but melasma can be unpredictable.
Although some procedures can reduce pigmentation, there is also a risk of inflammation and post-inflammatory pigmentation. Recurrence is also possible.
For these reasons, procedural treatments should be approached cautiously and as part of an overall management strategy rather than viewed as a simple cure.
How long does it take to improve melasma?
There is no fixed timeframe.
Some patients may notice gradual improvement over several weeks, while more established melasma may take several months to respond.
The important consideration is that melasma treatment is usually gradual.
Trying to accelerate the process with increasingly aggressive products or procedures may cause irritation and potentially make pigmentation worse.
Regular review can help determine whether the treatment is working and whether the skincare routine needs to be adjusted.
Can melasma be permanently cured?
There is currently no guaranteed permanent cure for melasma. This does not mean that it cannot be significantly improved.
Many people can achieve substantial reduction in pigmentation with an appropriate treatment and maintenance programme. However, the underlying tendency to develop melasma can remain.
Triggers such as sunlight, visible light, hormonal changes and inflammation can cause pigmentation to return.
This is why long-term maintenance and sun protection are so important.
What should you do if you think you have melasma?
Not every facial pigmentation is melasma.
Other conditions can cause brown or dark patches, and an individual pigmented lesion may occasionally require medical assessment rather than cosmetic treatment.
A medical consultation can help establish:
Whether the pigmentation is consistent with melasma
Its distribution and characteristics
Potential triggers
Your skin type and sensitivity
Current skincare products
Previous treatments
Whether medical skincare may be appropriate
Whether further dermatological assessment is required
Any new, changing, irregular or otherwise concerning pigmented lesion should be medically assessed rather than assumed to be melasma.
Melasma Treatment in Oxfordshire
At Oxford Cosmetic Clinic, we take a doctor-led approach to the assessment and management of pigmentation.
Where appropriate, Obagi Medical® skincare can form part of an individualised approach to melasma, uneven skin tone and sun-related pigmentation.
The emphasis is on understanding the underlying cause, protecting the skin from further pigmentation and introducing appropriate active ingredients in a controlled and sustainable way.
Because melasma can be persistent and recurrent, our aim is not simply to provide a short-term cosmetic solution, but to help patients understand their skin and develop a practical long-term skincare strategy.
Key points about melasma
Melasma is a common cause of facial pigmentation.
It is influenced by multiple factors, including UV exposure, visible light, hormones and genetic susceptibility.
It can be difficult to treat because the underlying tendency to develop pigmentation remains.
Sun and light protection are fundamental to management.
Medical skincare can play an important role.
Obagi Medical® can form part of a structured skincare programme where appropriate.
Prescription-strength ingredients require appropriate medical assessment and prescribing.
Excessive irritation can potentially worsen pigmentation.
Melasma can recur, so maintenance treatment is often important.
A medical assessment is advisable before assuming that facial pigmentation is melasma.
Medical information: This article is intended for general information and does not constitute individual medical advice. Prescription-only medicines are only supplied following an appropriate consultation and prescription where clinically indicated
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