Melasma and Facial Pigmentation: Causes, Treatment and Relapse

How is melasma different from other pigmentation?

Not every dark patch is melasma, and the type matters because each is treated differently:

More than one type can appear on the same face, and some new or changing dark spots need examining to make sure they are nothing else, so an accurate diagnosis is made by a dermatologist.

• Melasma: broad, symmetrical patches on both sides of the face with irregular edges, worsened by sun, heat and hormones.
• Sun spots (solar lentigines): small, well-defined spots on sun-exposed areas that increase with age.
• Post-acne marks (post-inflammatory hyperpigmentation): patches where spots or wounds used to be, fading gradually with time and care.

What causes melasma?

There is no single cause. Several factors activate the pigment-producing cells in the skin, mainly:

This is why one woman may develop melasma while her sister does not, despite the same sun exposure: susceptibility varies from person to person.

• Sunlight, the strongest trigger for both onset and relapse.
• Heat, even without direct sun, such as kitchen heat and hot weather.
• Hormonal changes, such as pregnancy and some contraceptive pills.
• Genetics and skin tone, as it is more common in olive and brown skin.
• Irritating cosmetic products.

How is melasma treated?

The foundation of treatment is a daily broad-spectrum sunscreen with SPF 30 or higher. A tinted sunscreen containing iron oxides is preferred, because it also blocks visible light, which worsens melasma. Without this step, no other treatment works well.

Your doctor may then recommend lightening creams. Some are available without a prescription, such as azelaic acid, vitamin C and kojic acid, while others need a prescription and follow-up, such as hydroquinone or combination creams used for set periods. Avoid lightening creams from unknown sources, as some contain harmful ingredients that can thin the skin or cause paradoxical darkening.

In some cases the doctor may prescribe an oral treatment such as tranexamic acid after assessing your general health, as it is not suitable for everyone.

Are peels and lasers suitable for melasma?

Superficial chemical peels and some lasers can speed up improvement, but they are used with great caution. Melasma is sensitive to heat and inflammation, and the wrong procedure or strong settings can make pigmentation worse rather than better, especially in olive and brown skin.

That is why these procedures usually come as a supporting step after several weeks of preparing the skin with creams and sun protection, using gentle sessions decided by the doctor.

It is also important not to combine several strong procedures or products at once in search of faster results, as irritation itself can increase pigmentation. A gradual plan followed and adjusted by your doctor according to your skin's response works better.

Why does melasma come back, especially in summer?

Melasma is chronic, and the pigment cells of people who have it are easily activated. A few days of sun or heat without protection can bring part of the patches back, even after clear improvement.

In Saudi Arabia the sun is strong for most of the year and peaks in summer with intense heat, so many people notice their melasma worsens in these months. The answer is not to stop treatment but to keep up daily protection and the maintenance treatment your doctor recommends.