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

2 June

Laser by Tom — Skin Journal

Melasma: What Causes It,
How It's Managed, What to Avoid

Melasma is one of the most misunderstood skin conditions. It can be managed well, but it can't be cured — and the order you do things in matters more than any single product or treatment.

Tom Seelbach Updated September 2026 10 min read

Understanding melasma

What Melasma Actually Is

Melasma is a form of acquired hyperpigmentation — symmetrical brown or grey-brown patches that develop when pigment cells (melanocytes) become overactive. It most commonly appears on the cheeks, upper lip, forehead and bridge of the nose, and occasionally on the neck or forearms.

What makes melasma different from a sunspot is that it's dynamic and chronic. It responds to sunlight, visible light and hormones, fades and returns with the seasons, and comes back after almost any treatment unless daily protection continues. Current thinking is that melasma involves more than melanocytes alone — the surrounding skin, including small blood vessels and support cells, is part of the picture, which is one reason single-target treatments tend to relapse.

It affects women far more often than men, is most common in olive and darker skin tones, and runs in families — around six in ten people with melasma have a relative with it.

"Melasma is a chronic condition, not a spot to be removed. The goal is control and maintenance — and the first step is a doctor, not a laser."

Tom Seelbach, Laser by Tom

The Root Causes

What Actually Drives Melasma

Melasma doesn't have a single cause — it develops from an interaction between genetic sensitivity, hormones, and light. Some of the popular "triggers" have good evidence behind them; others are plausible but unproven, and it's worth knowing which is which.

Well-established drivers

What the evidence supports

UV exposure — long-wave UVA in particular reaches deep into the skin and is the primary UV driver of melasma. It passes through cloud and through car and house windows
Visible light — the blue-violet part of sunlight induces darker, longer-lasting pigment in olive and darker skin than UVA does. Ordinary sunscreen filters, mineral or chemical, do not block it; only the iron oxides in a tinted product do
Hormones — pregnancy, the combined pill and hormone therapy are implicated in roughly a quarter of affected women
Genetics — a strong family history makes melasma more likely and, in the research, harder to shift
Inflammation — any irritation, from harsh skincare to aggressive treatments, adds post-inflammatory pigment on top of melasma, especially in darker skin

Plausible but less certain

Worth managing, not worth panicking about

Heat — there's a mechanism and some observational data linking sustained facial heat (saunas, hot yoga, cooking over open heat) to worse melasma, but no controlled trial. Reasonable to avoid; not the villain some articles make it
Thyroid — studies show a statistical link with thyroid autoimmunity, but Australian GP guidance says the evidence is still developing. Worth a check if melasma is severe or unusual, not a routine test
Some medications — a handful of drugs cause pigmentation that looks like melasma or worsens it. Bring your medication list to your doctor
Screens and phones — the one controlled study found no effect: screen light is hundreds to a thousand times weaker than sunlight. This is not a meaningful trigger

The depth factor: melasma can be epidermal (upper layers), dermal (deeper), or mixed — and most people have mixed. Deeper pigment is slower to respond and more prone to recurrence, which is one reason a staged, conservative approach beats aggressive treatment every time.

Step One

See Your GP or Dermatologist First

This is the part most laser clinics skip, and it's the most important thing on this page. Only a doctor can diagnose melasma. Several other conditions look similar — some of them respond very differently to treatment, and a couple are made worse by laser — so the diagnosis has to come first.

Doctors also have prescription options for melasma that I'm not able to discuss or advise on. In current Australian and international guidance those prescription treatments, combined with daily tinted sunscreen, are the first line of management; for many people they are the most effective part of a plan, and often the least expensive. Laser sits well behind them.

What to bring

Help your doctor help you

When it started and whether anything set it off — pregnancy, starting or changing contraception, a sunny holiday
Whether it runs in your family
A list of every product you put on your face, and your current sunscreen
Any previous treatments — creams, peels, IPL, laser — and how your skin responded
Your current medications
Dated photos. If you've had a consultation with me, I can give you photos and a short note of what I observed to take with you

What to ask

Questions worth raising

"Is this melasma, and is it mostly surface or deeper?"
"What should I use, for how long, and what does maintenance look like afterwards?"
"Is my contraception or hormone therapy relevant?"
"Is there anything in my routine I should stop?"
"Would adjunctive low-energy laser be reasonable at some point, and if so when?"

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 for melasma the tint matters more than the filter type or the SPF number.

Sunscreen filters — mineral and chemical alike — protect against UVA and UVB but let visible light straight through. Two controlled trials in melasma patients found that a tinted sunscreen containing iron oxides outperformed the identical untinted product, both during treatment and in preventing summer relapse. An untinted zinc sunscreen, however "mineral", gave no meaningful visible-light protection in testing. It is the iron oxides that do the work.

What to look for

The full protection picture

Tinted, with iron oxides — look for CI 77491, 77492 and 77499 on the ingredient list. An opaque, skin-toned product, not a sheer "glow"
SPF 50+ and "broad spectrum", with an AUST L number on the pack
Read the label, not the marketing. In 2025, independent testing found that many Australian facial sunscreens — mostly zinc-based "mineral" ones, several of them tinted — fell far short of their labelled SPF, and a number were withdrawn. "Mineral" is not a guarantee of anything
Lightweight texture so you'll actually apply enough of it, every day

Examples available locally

Products whose labels I've checked

La Roche-Posay Anthelios Tinted Fluid SPF 50+ — chemical-hybrid with iron oxides, single universal tint, good value and widely available
Mesoestetic Melan 130+ Pigment Control SPF 50+ — chemical-hybrid with titanium dioxide and all three iron oxides, formulated specifically for pigmentation-prone skin; sold through clinics and online in Australia
Invisible Zinc Sheer Defence Tinted SPF 50+ — 27% zinc oxide with an iron-oxide tint, for skin that prefers a mineral base. Two shades (Light and Medium), so it suits lighter to medium skin tones; deeper tones will find the chemical-hybrid options easier to match. This specific product was not part of the 2025 test failures
These are examples, not endorsements — always follow the product label. What matters is the tint (iron oxides on the list), an AUST L number, and using half a teaspoon for face and neck

The habits that matter as much as the product: half a teaspoon for face and neck (most people use a quarter of the tested amount); every morning, all year, cloudy days included; reapply every two hours outdoors; a broad-brimmed hat, which blocks the visible light and long UVA that no sunscreen fully stops; and remember that side and rear car windows and the window next to your desk let most UVA and all visible light through.

What Makes It Worse

Everyday Habits to Avoid

Sun protection is well known. These are the other habits I see undoing people's progress — some with strong evidence behind them, some plausible enough to be worth avoiding at no cost.

Avoid

Irritation & Injury

Scrubs, home peels, strong acids and over-exfoliating — barrier damage turns into inflammation, and inflammation turns into more pigment, especially in olive and darker skin
DIY remedies — lemon juice, apple cider vinegar, baking soda. Citrus is phototoxic and the pH injury adds pigment
Fragrance and essential oils on the face — especially citrus oils, which react with sunlight
Picking, rubbing, vigorous towel-drying, cleansing brushes
IPL and aggressive laser or peel treatments — heat-based and high-energy treatments are the most common cause of "worse after treatment" I see

Likely, not proven

Heat & Light Devices

Saunas, steam rooms, hot yoga, very hot showers — there is a plausible mechanism and some observational data linking sustained facial heat to worse melasma, but no controlled trial. Avoiding it costs nothing, so I suggest you do
Infrared LED masks — near-infrared generates heat in the skin. I'd pause them while melasma is active
Waxing or threading the upper lip and brows — heat, friction and inflammation over the exact areas melasma likes. A common clinical observation rather than a studied one

Talk to your doctor

Hormones & Medicines

The combined pill and hormone therapy can be relevant. Raise it with your GP — don't stop anything yourself
Certain medications cause pigmentation that mimics or worsens melasma. Bring your list to your appointment
Screens and phones — not a meaningful trigger. The only controlled study found no effect. Spend your effort on the window next to your desk instead

At Home

A Simple Routine — Fewer Products, Used Consistently

Over-the-counter skincare is a support act, not the main event — your doctor's plan and your sunscreen are what move melasma. But a gentle, consistent routine with one well-chosen brightening ingredient may help the appearance of uneven tone and keeps your skin calm, which matters more than people think. Stacking three acids adds irritation, not results.

1

Gentle, fragrance-free cleanser — morning and night

Or just water in the morning. No scrubs, brushes or exfoliating pads. The single most under-rated melasma product is a boring cleanser.
2

Niacinamide serum (4–10%) — morning

Vitamin B3. Gentle, well tolerated on almost every skin type, and in a small head-to-head study it held its own against a prescription comparator with fewer side effects. A sensible base for any melasma routine.
3

Tinted SPF 50+ — every morning

See above. If you do nothing else on this list, do this. Wait a few minutes before makeup and press it on rather than rubbing — a tinted SPF can be your base.
4

One brightening active — evening

Pick one, not three. Good over-the-counter options with reasonable evidence for the appearance of uneven pigmentation: azelaic acid 20% (Azclear, from the chemist — the strength the studies used; the 10% versions have less behind them), thiamidol (Eucerin Anti-Pigment range), or a tranexamic acid serum. Start every second night and build up. Azelaic acid is generally regarded as low-risk in pregnancy — confirm with your GP.
5

Bland moisturiser — and, optionally, low-strength retinol

A simple ceramide moisturiser at night. Once everything else is comfortable, a low-strength retinol two or three nights a week can help with turnover — but a harsh retinol start irritates the skin and sets melasma back, so go slowly. Not in pregnancy.

Two rules: if anything stings for more than a minute or leaves you red, stop it — irritation is a melasma trigger in its own right. And your doctor's advice overrides this page: they may ask you to pause some of these while you're on a prescribed treatment. Avoid any "skin lightening" product that doesn't disclose its ingredients — some imported products contain mercury or other harmful compounds.

Where Laser Fits

Laser Is Not a First-Line Treatment for Melasma

I run a laser studio, so this may not be what you expect me to say. Every current guideline — including the Australian GP guidance — places laser last, as an add-on for melasma that hasn't responded to sun protection and a doctor's plan. The reason is simple: melasma is heat- and inflammation-sensitive, and any device that overheats the skin can cause a rebound darker than what you started with. The research is clear that laser results for melasma are short-lived unless daily protection and maintenance continue, and that aggressive or frequent laser sessions can cause lasting patchy lightening.

Within those limits, low-energy picosecond laser may help improve the appearance of persistent pigmentation as part of a wider plan. Picosecond pulses transfer less heat than older nanosecond lasers or IPL, which is why they are the type used for melasma when laser is used at all. But the settings, the intervals, and the sequencing with your doctor's treatment matter more than the machine.

How I approach it

Melasma at Laser by Tom

No laser until you've been medically assessed. If the pattern I see may be consistent with melasma, I'll give you photos and a note for your GP first
Laser only as an add-on once sun protection and your doctor's plan are in place — ideally with your doctor aware
Very low energy, large spot, few passes, a fixed short course with four or more weeks between sessions — then stop and maintain
A test area first on olive and darker skin
Tinted SPF 50+ every day throughout, and no heat or irritation triggers
Honest expectations — management, not cure, and results are not permanent

What causes treatment failure

Why melasma laser goes wrong

Treating undiagnosed pigmentation — some melasma look-alikes are made worse by laser
Using laser as the main treatment instead of an add-on
Aggressive settings that cause rebound darkening or patchy lightening
Sessions too close together, or open-ended monthly "toning" that never stops
IPL, ablative resurfacing or heavy peels on melasma
No sunscreen compliance between sessions, and no maintenance afterwards

Managing Expectations

What's Realistic for Melasma

This needs to be said clearly: melasma cannot be cured. It can be reduced, well managed and kept at a level most people are comfortable with — but the underlying tendency doesn't go away, and it will test you every summer.

What realistic management looks like: a diagnosis from your GP or dermatologist; their plan, followed properly, judged over two to four months rather than weeks; tinted SPF 50+ and a hat every day for life; a gentle routine with one brightening active; and, for some people, adjunctive low-energy laser later on, coordinated with their doctor. Expect it to darken in summer and lighten in winter even when you do everything right, and expect to go back to your doctor when it flares rather than reaching for something harsh.

The people who do best are the ones who commit to the whole picture and think in years, not sessions.

Common Questions

Frequently Asked

Why won't you laser my melasma straight away?

Because only a doctor can diagnose it, several look-alike conditions respond very differently to laser, and every current guideline puts laser last — after sun protection and prescription treatment. Treating suspected melasma with laser as a first step is the most reliable way to make it worse. Once you've been assessed and are on a plan, we can talk about whether low-energy laser has a role for you.

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

Sometimes, partially. Hormonally triggered melasma can fade once the trigger is removed, but it often doesn't disappear completely, particularly if it's been there for years or has a deeper component, and sunlight tends to maintain it once it's established. Most people still benefit from a doctor's plan and daily tinted SPF. Don't stop or change contraception without talking to your GP.

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

Pure red LED at low intensity for short sessions is lower risk. Near-infrared generates heat in the skin, and most home masks combine red and infrared, so I'd pause the mask while melasma is active. The evidence here is mechanistic rather than from trials — it's a "why risk it" rather than a "proven harm".

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

Yes — classic melasma behaviour, and one of the clues that distinguishes it from a sunspot. UV and visible light are stronger and you're outdoors more. The management is the same year-round, but summer is where sunscreen habits and a hat earn their keep.

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

No laser or peels during pregnancy or breastfeeding. Daily tinted SPF 50+ and a wide-brimmed hat are the most useful things you can do, with a gentle routine. Some brightening ingredients — prescription and over-the-counter — are not recommended in pregnancy, so ask your GP which are appropriate for you; azelaic acid is generally regarded as low-risk but confirm it. Melasma that starts in pregnancy often improves after delivery.

How is melasma different from a sunspot?

Sunspots (solar lentigines) are caused by cumulative UV, are discrete and well-defined, and don't change with hormones or seasons. Melasma is diffuse, usually symmetrical, hormonally influenced and fluctuates seasonally. Sunspots respond well to Pico laser; melasma needs a doctor's diagnosis and plan first, with laser only as a possible add-on. Treating melasma like a sunspot is one of the most common mistakes that leads to rebound.

Will melasma come back after treatment?

Expect it to, whatever the treatment — prescription, over-the-counter or laser — unless daily protection and maintenance continue. In the research, recurrence within three to six months after a course of laser is the norm without maintenance. That isn't a failure of the treatment; it's the nature of the condition. Plan for maintenance from the start.

When should I go back to my doctor?

If patches darken quickly or spread despite protection; if the colour turns grey, blue or speckled; if you notice new pale spots within the patches; if your skin becomes persistently red or thin on a prescribed treatment; or if any single spot is changing, raised, itchy or bleeding — that isn't melasma and needs checking.

The Bottom Line

Melasma Is Manageable — In the Right Order.

Diagnosis first. Then tinted sunscreen and your doctor's plan. Then a gentle, consistent routine. Then — for some people, later — low-energy laser as an add-on, coordinated with your doctor. Done in that order, most people reach a level they're happy with and keep it there.

What doesn't work is skipping to the laser, treating it aggressively and hoping, or treating the patches without addressing what's driving them. If your melasma keeps coming back, it's almost always because sunlight, visible light, hormones or irritation are still active — or because there was never a maintenance plan.

If you'd like a second pair of eyes before your GP appointment, book a consultation. I'll look at your skin, tell you honestly what I'm seeing, and give you photos and a note to take to your doctor. Where laser has a role later, we'll plan it properly.

Tom Seelbach — Laser by Tom, Bondi Junction

Tom operates a private, appointment-only laser studio in Bondi Junction, working with Pico laser for pigmentation, the Candela VBeam for rosacea and vascular concerns, and CO₂ fractional laser for acne scars and skin rejuvenation. All treatments are performed personally by Tom, a trained laser operator. Tom is not an AHPRA-registered health practitioner. Treatments are provided as non-medical aesthetic laser services; melasma requires diagnosis and management by a GP or dermatologist, and clients are referred accordingly. This article is general information, not medical advice. Individual results vary. Product mentions are examples, not endorsements.

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Tom Seelbach