Patient information · Dermatology
Melasma
controllable, recurrent, and easily made worse
Melasma causes symmetrical brown or grey-brown patches, usually on the cheeks, forehead, upper lip and jawline. It is driven by sun, heat and hormones, and it is far more common in people with darker skin. Treatment works, but without daily sun protection nothing else does.
Have a pigmented patch assessed if it is
- on one side only, or a single well-defined lesion rather than symmetrical patches
- changing in size, shape or colour, or has an irregular border
- raised, itchy, bleeding or crusting
- new and darkening rapidly
- accompanied by widespread darkening, fatigue and weight loss
Melasma is symmetrical and flat. Anything asymmetric, raised or changing needs examining to exclude a skin cancer. Generalised darkening with fatigue can indicate Addison's disease and warrants blood tests.
Never use unregulated skin-lightening creams
Products bought online, from market stalls or brought from abroad frequently contain mercury, potent steroids or high-dose hydroquinone, none of which appear on the label. They cause skin thinning, stretch marks, permanent blue-grey discolouration (ochronosis) that is far worse than the original problem, adrenal suppression, and in the case of mercury, kidney damage. They are illegal to sell in the UK for this purpose. If you have been using one, stop and come and talk to us — stopping potent steroids abruptly after long use needs managing.
What drives it
- Ultraviolet light, and importantly visible light — including from screens and indoor lighting, which ordinary sunscreens do not block
- Heat — cooking, saunas, hot climates. Independent of light.
- Hormones — pregnancy (the 'mask of pregnancy'), the combined pill, and HRT
- Genetics and skin type — much more common in Asian, Middle Eastern, Hispanic and Black skin
- Irritation — harsh scrubs, aggressive peels and waxing can worsen it
- Certain medicines that increase light sensitivity
Sun protection — this is the treatment
- SPF 50 every single day, all year, including indoors near windows and on cloudy days.
- Use a tinted mineral sunscreen containing iron oxides. This is the key detail most people miss — iron oxides block visible light, which drives melasma and which clear chemical sunscreens do not filter.
- Reapply every two to three hours when outdoors.
- Wide-brimmed hat and sunglasses; sit away from direct sun and heat.
- Consider stopping the combined pill or reviewing HRT, if that fits the timing.
Prescription treatment
- Azelaic acid — effective, safe in pregnancy, and a reasonable first choice.
- Topical hydroquinone, prescribed and time-limited, remains the most effective single agent. It must not be used continuously long term.
- Combination creams containing a retinoid and mild steroid alongside, used in cycles under supervision.
- Oral tranexamic acid has good evidence in resistant melasma, prescribed with care and not suitable if you have a clotting risk.
- Chemical peels and laser can help but are double-edged — used wrongly, particularly on darker skin, they cause rebound pigmentation that is harder to treat than the original. Anyone offering laser for melasma should be experienced with your skin type.
- Expect three to six months before judging, and understand that melasma is controlled rather than cured — it recurs with sun and hormone exposure.
Why come to us. Melasma is commonly treated with whatever is on a shelf, and often made worse. Our dermatology and aesthetics teams confirm the diagnosis, distinguish it from post-inflammatory pigmentation and from lesions needing removal, and prescribe treatments not available over the counter — with a plan for the sun protection that determines whether any of it works. We have particular experience treating pigmentation in skin of colour, where the wrong treatment does lasting harm. Seven days a week, no referral.
Prescription treatment, and experience with skin of colour
Dermatology and aesthetics on site, no referral. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.