Melasma is one of the most common and most frustrating skin concerns we manage at our clinic. Patients come in having tried multiple treatments — creams, peels, lasers — only to see the pigmentation return weeks or months later. The recurrence is not a treatment failure. It is a consequence of not understanding what melasma is and how it must be managed long-term. This post gives you that understanding.
What Melasma Is
Melasma is a chronic acquired hypermelanosis — an increase in melanin production in the skin — that predominantly affects the face. It presents as symmetrical, irregular brown or grey-brown patches typically on the cheeks, forehead, upper lip, and bridge of the nose. It is driven by three primary factors: UV exposure, hormonal influence (oestrogen and progesterone), and genetic predisposition. Indian skin, with its higher baseline melanocyte activity, is particularly susceptible.
Why It Keeps Coming Back
Melasma recurs because the underlying drivers — UV exposure and hormonal sensitivity — are not eliminated by any treatment. Chemical peels, lasers, and depigmenting creams remove or suppress existing pigmentation. But the melanocytes that produced that pigmentation remain, and they remain sensitised. Any UV exposure — even minimal, even through glass — can reactivate them. Any hormonal fluctuation — a new contraceptive, a pregnancy, a change in thyroid function — can flare the condition. This is why melasma is managed, not cured.
What Actually Works
The most important single intervention is rigorous, consistent, daily broad-spectrum sunscreen — SPF 50, PA++++, applied every morning without exception, reapplied during outdoor exposure. No other treatment works in the absence of this. Topical depigmenting agents — azelaic acid, kojic acid, tranexamic acid, arbutin — reduce melanin production and are used as daily maintenance. Tretinoin accelerates cell turnover and enhances the effect of other depigmenting agents. For more rapid clearance, superficial chemical peels (glycolic, lactic, tranexamic acid-based) used monthly produce consistent improvement. Laser treatments — Q-switched and picosecond lasers — are effective but must be used with caution in Indian skin by experienced operators; aggressive laser treatment of melasma can worsen it through PIH.
The Long-Term Mindset
Managing melasma requires accepting that it is a chronic condition with a maintenance phase that does not end. Patients who achieve clearance and then stop sunscreen and maintenance products reliably experience recurrence. Those who maintain their protocol — sunscreen daily, topical maintenance, periodic clinic treatments — maintain their results. The goal is not to cure melasma; it is to keep it consistently suppressed.
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— Dr. Nishita Ranka | Consultant Dermatologist | Dr. Nishita’s Clinic for Skin, Hair & Aesthetics, Hyderabad
