Melasma: What Causes It, How to Treat It, and What to Avoid

2 June

Laser by Tom — Skin Journal

Melasma: What Causes It,
How to Treat It, What to Avoid

Melasma is one of the most misunderstood and mistreated skin conditions. Most people focus on the patches — but the triggers hiding in plain sight are what keep it coming back.

Tom Seelbach June 2026 9 min read

Understanding melasma

What Melasma Actually Is

Melasma is a form of acquired hyperpigmentation — patches of darkened skin that develop when melanocytes (the cells that produce pigment) become overactive. It most commonly appears on the cheeks, upper lip, forehead, and chin, often in a symmetrical pattern on both sides of the face. Occasionally it appears on the neck, forearms, or décolletage.

What makes melasma different from other pigmentation is that it's dynamic. It responds to hormones, heat, UV, and visible light — which means it can worsen significantly with certain everyday habits, and can rebound after treatment if those habits aren't changed. Understanding this is the key to managing it effectively long-term.

It affects women far more commonly than men — around 90% of melasma cases are in women — and is particularly prevalent in people with darker or olive skin tones (Fitzpatrick types III–V), though it can affect all skin types.

"Melasma is not just a pigmentation problem. It's a chronic skin condition with hormonal, UV, and heat triggers. Treating the patches without addressing the triggers is why it keeps coming back."

Tom Seelbach, Laser by Tom

The Root Causes

What Actually Causes Melasma

Melasma doesn't have a single cause — it develops from an interaction between hormonal sensitivity, UV exposure, and heat. All three are usually present to some degree.

Primary causes

What triggers melasma initially

Hormonal changes — oestrogen and progesterone stimulate melanocytes to produce excess pigment. Pregnancy (chloasma, or the "mask of pregnancy") is the most common trigger, but the combined oral contraceptive pill, hormone replacement therapy (HRT), and even some IUDs can trigger it
UV exposure — UVA and UVB radiation directly stimulate melanocytes and are required for most melasma to activate. Without UV, hormonal melasma is usually far less pronounced
Visible light (HEV / blue light) — even without UV, high-energy visible light from the sun and screens can activate melasma in darker skin tones. This is why mineral sunscreen matters — chemical SPF doesn't protect against visible light
Genetic predisposition — melasma runs in families. If a parent or sibling has it, you're at higher risk

Worsening factors

What makes existing melasma darker

Heat — even without UV, heat directly stimulates melanocyte activity. Saunas, hot showers, exercise, and hot environments all worsen melasma — this is one of the least known but most significant aggravating factors
Inflammation — any inflammatory process in the skin (including aggressive skincare, harsh laser settings, or skin injury) can trigger post-inflammatory darkening on top of existing melasma
Thyroid dysfunction — there's a well-documented association between melasma and thyroid disorders. If melasma is severe and difficult to manage, thyroid function is worth checking with your GP
Some medications — phototoxic drugs (certain antibiotics, retinoids at high doses, some blood pressure medications) can intensify melasma

The depth factor: melasma can be epidermal (upper skin layers), dermal (deeper), or mixed. Epidermal melasma responds better to laser and topicals. Dermal melasma is harder to treat and more prone to recurrence. In practice most people have mixed melasma — which is why a staged, conservative approach works better than aggressive treatment.

The Triggers You Might Not Know About

Heat, Saunas, LED Masks & More — What to Avoid

This is the section most skincare guides skip. Sun protection is well known — but there are several everyday habits and popular wellness trends that quietly worsen melasma without people realising why their patches keep coming back.

Avoid entirely

High Heat Sources

Saunas (all types) — including infrared saunas, which are particularly problematic because infrared radiation penetrates deeply into the skin and generates significant heat at the dermal level where melasma sits. Regular sauna use is one of the most common unrecognised triggers I see in clients whose melasma won't settle
Steam rooms — same principle as saunas. Even short exposures add up over time
Hot yoga — the combination of heat and physical exertion is a reliable melasma trigger. If you do hot yoga regularly, expect melasma to be harder to manage
Very hot showers — the face in a hot shower is a chronic low-level heat exposure many people don't consider

Use with caution

Light-Emitting Devices

Infrared LED masks — infrared wavelengths generate heat in the skin and can directly worsen melasma. Popular at-home devices that combine red and near-infrared light should be used cautiously or avoided if melasma is active
Red LED light (alone) — lower risk than infrared, but still generates some heat. If you use red LED for skin rejuvenation, keep sessions short and cool the skin well afterwards
Blue LED light — blue light is specifically implicated in visible-light-triggered melasma. Limit prolonged exposure from both LED devices and screens if your melasma is reactive to visible light
IPL treatments — IPL can temporarily improve melasma surface appearance but frequently causes rebound darkening due to its heat-based mechanism. Not recommended for active melasma

Be mindful

Skincare & Lifestyle

Aggressive exfoliation — physical scrubs, high-strength AHAs, and over-exfoliation cause inflammation that triggers post-inflammatory darkening on top of melasma
Fragrance in skincare — fragrance is phototoxic in some formulations and can contribute to irritation-triggered darkening
Retinoids at high doses — high-strength retinol can cause initial skin irritation that worsens melasma, though low-dose retinoids are actually helpful for melasma management once skin is tolerant
Alcohol consumption — causes vasodilation and a heat response in the skin; regular alcohol use is a low-grade melasma aggravator
Prolonged screen exposure — relevant for those with visible-light-sensitive melasma, particularly on darker skin tones

Infrared saunas specifically: I want to flag this clearly because they're extremely popular at the moment and most people assume they're skin-positive. For melasma skin, regular infrared sauna use is one of the most reliable ways to keep melasma active. The infrared heat penetrates deeply, directly stimulating melanocytes regardless of sun exposure. If you have melasma and use an infrared sauna regularly, this is very likely contributing to your patches persisting.

The Right Sunscreen for Melasma

Not All SPF Is Equal — Especially for Melasma

Most people with melasma know they need sunscreen. What fewer people know is that the type of sunscreen matters specifically for melasma — in a way it doesn't for most other skin conditions.

Chemical sunscreens protect against UVA and UVB radiation, but they do not protect against visible light (HEV / blue light). For many melasma sufferers — particularly those with darker skin tones — visible light is a significant independent trigger. Using a chemical-only sunscreen may protect against sunburn while still allowing the visible light component to worsen melasma.

What melasma skin needs from SPF

The full protection picture

UVB protection — prevents sunburn and direct melanocyte activation
UVA protection — long-wave UVA (UVA1) penetrates deepest and is the primary UV driver of melasma
Visible light / HEV protection — only mineral filters (zinc oxide, titanium dioxide) and iron oxides provide meaningful protection against visible light. This is what makes mineral SPF essential for melasma, not just preferred
Heat minimisation — choose lightweight formulas that don't trap heat. Heavy occlusive SPFs add another heat layer to the skin

Tom's recommendations for melasma

What to use daily

Invisible Zinc Sheer Defence SPF 50+ — high zinc oxide content, lightweight finish, excellent visible-light coverage. Tom's primary recommendation for melasma clients. Tinted versions provide additional iron oxide coverage for visible light protection
La Roche-Posay Anthelios Tinted — the tinted mineral version specifically, as the iron oxides add an important layer of visible light protection on top of the mineral filters
Apply generously — a thin swipe is not enough. Half a teaspoon for face and neck
Reapply every 2 hours during outdoor exposure
Wear a wide-brimmed hat on top — physical barrier is the most reliable sun protection of all

The tinted sunscreen advantage: tinted mineral sunscreens contain iron oxides — the pigments that give them their colour — which happen to absorb visible light. A tinted mineral SPF 50+ provides UVA + UVB + visible light protection simultaneously. For melasma clients, this is the most comprehensive single product you can use daily.

Treating Melasma

How Pico Laser Treats Melasma — and Why the Approach Matters

Melasma can be significantly improved with Pico laser — but only when it's approached carefully. This is where melasma treatment differs fundamentally from standard pigmentation treatment, and where getting the approach wrong causes the most damage.

The risk with laser and melasma: heat triggers melanocyte activity. Any laser that generates significant heat in the skin can cause a rebound where the melasma darkens more than it improves. This is why older Q-switched lasers and IPL are frequently problematic for melasma — they generate more heat than Pico laser does, and heat is the enemy.

Pico laser works differently. Its ultra-short pulse duration (measured in picoseconds — trillionths of a second) means energy is delivered so rapidly that the thermal (heat) component is significantly lower than nanosecond lasers. It shatters pigment through photoacoustic (pressure wave) rather than primarily photothermal (heat) energy. This makes it meaningfully safer for melasma — but the settings, density, and spacing still need to be carefully managed.

The correct approach

How melasma is treated at Laser by Tom

Conservative, low-density settings — less energy per session, more sessions
Sessions spaced further apart (6–8 weeks) to let the skin fully settle between treatments
Combined with a topical protocol — vitamin C serum, niacinamide, and/or azelaic acid in between sessions to suppress melanocyte activity
Mineral SPF 50+ (ideally tinted) every single day throughout the treatment course
Avoiding all identified heat and light triggers during and after treatment
Realistic expectation setting — melasma management, not a cure

What causes treatment failure

Why melasma laser doesn't always work

Aggressive settings that generate rebound darkening (often worse than the starting point)
Sessions too frequent — skin doesn't have time to settle before the next stimulus
No SPF compliance between sessions — UV exposure reactivates melanocytes between treatments
Ongoing triggers not addressed — continuing sauna, hot yoga, or hormonal contraception that's driving the melasma
Using IPL instead of Pico — heat-based mechanisms are higher risk
Treating active, inflamed melasma rather than waiting for it to settle first

Supporting Skincare

What to Use Between Laser Sessions

Laser alone is not enough for melasma. The most effective approach combines laser with a consistent topical routine that suppresses melanocyte activity between sessions. Here's what actually works.

1

Vitamin C serum (morning) — L-ascorbic acid 10–20%

Vitamin C inhibits tyrosinase — the enzyme responsible for melanin production. Applied in the morning under SPF, it reduces melanocyte activity and brightens existing pigmentation. Look for a stable, low-pH formulation. Start at 10% if you have sensitive skin and build up.
2

Niacinamide 5–10% (morning or evening)

Niacinamide (vitamin B3) reduces the transfer of melanin to skin cells and has anti-inflammatory properties that calm melanocyte overactivity. Well tolerated even on sensitive skin. Works well layered with vitamin C or used in the evening if vitamin C is worn in the morning only.
3

Azelaic acid 10–20% (evening)

One of the most evidence-backed ingredients for melasma specifically. Azelaic acid selectively targets overactive melanocytes without affecting normal melanin production, reduces inflammation, and is safe during pregnancy (unlike many other brightening actives). Available in 10% over the counter and 20% on prescription from a GP or dermatologist.
4

Low-dose retinol (evening, once or twice a week)

Retinoids increase cell turnover, which helps shift pigmented cells to the surface faster. At low doses (0.025–0.05%), retinol is beneficial for melasma without causing the irritation that worsens it. Not recommended during pregnancy. Introduce slowly — once a week, increasing to three times once tolerated.
5

Tinted mineral SPF 50+ (morning, every day)

The single most important product in any melasma routine. Applied generously, every morning, regardless of weather or plans. Reapplied during the day if outdoors. This is not optional — it's the foundation everything else builds on.

What not to use on melasma: hydroquinone (a common prescription brightener) is effective short-term but is restricted in Australia and associated with a condition called ochronosis (permanent blue-black skin discolouration) with prolonged use. Kojic acid can be helpful but causes irritation in some people. Avoid any product marketed as a "skin lightener" that doesn't disclose its active ingredients — some contain mercury or other harmful compounds.

Managing Expectations

What's Realistic for Melasma

This needs to be said clearly: melasma cannot be permanently cured. It can be significantly reduced, well managed, and kept at a level most people are comfortable with — but the underlying tendency for melanocytes to overproduce pigment in response to hormones, heat, and UV doesn't go away.

What realistic treatment looks like: an initial course of 4–6 Pico laser sessions combined with a consistent topical protocol and trigger management, followed by maintenance sessions every 6–12 months and daily SPF for life. Most clients reach a point where their melasma is barely visible day-to-day and maintain it with one or two sessions per year.

The clients who do best are those who commit to the full picture — not just the laser sessions, but the SPF, the skincare, and the lifestyle adjustments. The laser does the heavy lifting on existing pigment, but the daily habits are what prevent it from returning.

Common Questions

Frequently Asked

I've stopped the pill — will my melasma go away on its own?

Sometimes, partially. Hormonally triggered melasma can fade once the hormonal trigger is removed — but it often doesn't disappear completely, particularly if it's been present for years or has a dermal component. UV exposure tends to maintain melasma independently of hormones once it's established. Most people find it improves after stopping the pill but still benefits from active treatment and ongoing SPF.

Can I use my at-home LED mask if I have melasma?

It depends on the device. Pure red LED (around 630–660nm) at low intensities and short durations is lower risk. Near-infrared (800–900nm+) generates significant heat and should be avoided on active melasma. Devices that combine red and infrared — which most at-home LED masks do — should be used with caution or avoided entirely until your melasma is well controlled. If you're actively treating melasma, I'd pause LED mask use during the treatment course.

My melasma gets worse in summer every year — is that normal?

Yes — this is classic melasma behaviour. UV and visible light in summer directly trigger melanocytes, and heat from the environment adds to it. Many people see their melasma fade noticeably in winter and return in summer. This seasonal pattern is one of the diagnostic clues for melasma versus other pigmentation types. The management approach is the same year-round, but sun protection and trigger avoidance are even more critical during summer months.

I'm pregnant — what can I do about melasma now?

Laser treatment is not appropriate during pregnancy or breastfeeding. The safest active ingredient during pregnancy for melasma is azelaic acid (up to 20%), which is rated Category A in Australia — considered safe in pregnancy. Vitamin C is also generally considered safe. Avoid retinoids, salicylic acid at high doses, and hydroquinone during pregnancy. The most important thing you can do is daily tinted mineral SPF 50+ and a wide-brimmed hat — limiting UV and visible light exposure reduces how much the melasma progresses during pregnancy.

How is melasma different from a sunspot?

Sunspots (solar lentigines) are caused purely by cumulative UV exposure and are stable — they don't change with hormones or seasons, just gradually accumulate with age. They tend to be well-defined, discrete spots. Melasma is diffuse, often symmetrical, hormonally influenced, and fluctuates seasonally. Both can be treated with Pico laser, but the approach, settings, and protocols are different. Getting the diagnosis right before treatment is essential — treating melasma like a sunspot is one of the most common mistakes that leads to rebound.

Will melasma come back after laser treatment?

It can — particularly without ongoing trigger management and SPF compliance. The pigment cells cleared by laser are gone, but the underlying tendency for melanocytes to overproduce pigment remains. Most clients find that with consistent SPF, trigger avoidance, and an annual or biannual maintenance session, they keep their melasma at a level they're happy with long-term. The goal is management rather than permanent cure.

The Bottom Line

Melasma Is Manageable — With the Right Approach.

Melasma is one of the conditions I take the most care with — because the margin between meaningful improvement and making things worse is narrower than with most other pigmentation types. The right laser at the right settings, combined with the right topicals, the right sunscreen, and genuine trigger management, can reduce melasma to a level most people are very happy with.

What doesn't work is treating it aggressively and hoping for the best, or treating the patches without understanding and addressing what's driving them. If your melasma keeps coming back, it's almost always because a trigger — heat, UV, visible light, hormones, or a combination — is still active.

Every melasma consultation at Laser by Tom is free. We'll look at your specific presentation, identify your likely triggers, and build a plan that addresses both the existing pigmentation and the reasons it keeps returning.

Tom Seelbach — Laser by Tom, Bondi Junction

Tom operates a private laser skin clinic in Bondi Junction, specialising in Pico laser for pigmentation and melasma, the Candela VBeam for rosacea and vascular conditions, and CO₂ fractional laser for acne scars and skin rejuvenation. All treatments are performed personally by Tom. Free consultations available.

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Tom Seelbach