Your guide to Melasma: Symptoms, Causes and Treatment

by Dr Wan Chee Kwang
September 21, 2023

Melasma is a skin condition that transcends age and skin type, impacting individuals from all walks of life. However, the factors that give rise to melasma aren't always understood by everyone. 

In this comprehensive guide, we share about melasma, its symptoms, causes, and what pigmentation removal treatments you can explore. This guide will help you figure out the best way to manage your melasma.

Understanding melasma

Melasma can leave you with patches of discoloured skin on your face, affecting your appearance. It is predominant in women, especially those with darker skin tones, and is common during pregnancy and hormonal changes. 

While melasma doesn't cause physical discomfort, its visible nature can affect your self-confidence. To treat melasma effectively, we must understand the causes behind it.

Symptoms of melasma

Dark patches

The most noticeable sign of melasma is the appearance of distinct patches of brown or greyish pigmentation on your face. These patches often materialise on areas like the cheeks, forehead, bridge of the nose, and upper lip. 

Symmetry and sun sensitivity

Melasma often exhibits a symmetrical pattern, meaning that if you have patches on one side of your face, you're likely to see similar patches on the other side. These patches might darken upon sun exposure and may become more prominent from excessive sun exposure. 

Causes and risk factors

Hormonal changes

Hormonal changes play a significant role in the development of melasma. Pregnancy, hormonal medications, and even hormonal fluctuations due to birth control can trigger or exacerbate this condition. The changes in hormones stimulate the production of melanin, making one more prone to skin darkening.

Sun exposure 

Sun exposure is another significant contributor, as ultraviolet (UV) rays stimulate melanocytes to produce more pigment.


Individuals with a family history of melasma are more likely to develop it themselves, highlighting the genetic component of the condition.

The presence of one or more of these factors creates the perfect combination for melasma to manifest. 

Melasma vs pigmentation

Melasma and pigmentation are related conditions, but they are not exactly the same. Melasma is a specific type of pigmentation disorder. 

While both involve the irregular production of melanin, the pigment responsible for skin colour, there is a distinct difference between the two - melasma's development is primarily caused by hormonal fluctuations that stimulate melanin production.

Differentiating between the two is key in defining an appropriate treatment based on the specific condition and its underlying causes.

Diagnosis of melasma

Melasma is typically diagnosed through a visual examination by a healthcare professional experienced in skin conditions. The diagnosis involves assessing your medical history, examining the affected areas, and considering potential triggers.

Your doctor might also use a Wood's lamp, which emits ultraviolet light, to evaluate the extent of melasma. This assessment helps determine the appropriate pigmentation removal treatment plan for your condition.

Treatment options for melasma

Managing melasma can be challenging, but various pigmentation removal treatment options can help lighten or even clear the pigmentation.

Laser treatment and medication combination

One approach that has shown results involves a combination of laser pigmentation treatment and medication, both topical and oral.

While there's no magic solution to make melasma disappear permanently, this combination approach has demonstrated good results in lightening pigmentation and managing its production. The laser treatment targets the darkened skin cells, while medication such as tranexamic acid suppresses melasma activity within the skin.

Fractional ruby laser

Dr Wan of 1Aesthetics recommends using a fractional ruby laser for treating melasma. It is a device that emits a ruby-coloured wavelength of 694 nanometers through a special micro lens array that produces focused high energy, clearing stubborn pigmentation effectively while reducing the risk of complications.

The laser light from the ruby laser is absorbed well by pigmentation and results in fewer complications like hyperpigmentation, hypopigmentation and blistering. There is minimal downtime since the laser doesn’t damage the surrounding skin and tissue in the treatment area. 

Pico Laser

Pico laser is an advanced skin treatment using ultra-short light pulses to target pigmentation and rejuvenate skin. Nanosecond q-switched lasers have been largely replaced by newer picosecond lasers, which are safer and more effective in targeting melasma. 

Dr Wan prefers using the fractional microlens array handpiece and ruby wavelength from Pico Lasers due to their higher specificity for melanin. This specificity reduces the risk of noticeable white spots, ensuring a more even and natural-looking outcome.

Fractional microneedle radiofrequency

Fractional microneedle radiofrequency is a non-invasive treatment using tiny needles and radiofrequency energy to improve skin texture and appearance. 

Adding fractional microneedle radiofrequency to the pigmentation removal treatment program can further enhance the effects of laser treatment. This technique improves treatment efficacy and reduces complications by potentially stabilising the activity of melasma. 

Coping with melasma psychologically

Melasma patches can cause feelings of self-consciousness and diminished self-esteem. However, there are strategies you can adopt to navigate these emotional challenges and regain your confidence.

  1. Seek support

Opening up to friends, family, or a mental health professional about your feelings can help alleviate the burden of dealing with melasma alone.

  1. Set realistic expectations

There is no permanent cure for melasma but it can be controlled and improved significantly. It’s important to set realistic expectations and understand that managing melasma is a gradual process.

Prevention & maintenance strategies

While melasma can be tricky to prevent, there are steps you can initiate to minimise its occurrence.

  1. Sun protection

Sun exposure is a trigger for melasma. We recommend using a broad-spectrum sunscreen with at least SPF 30 to prevent its development or worsening, even on cloudy days. 

  1. Avoid hormonal triggers

If you're prone to melasma due to hormonal fluctuations, consult your healthcare provider. They can help you explore hormonal therapies or manage the potential impact on melasma.

  1. Maintain a consistent skincare routine

A consistent skincare routine with products containing skin-brightening ingredients like vitamin C and arbutin can help manage melasma's effects.

  1. Take oral medications and supplements

You can also take various medications and supplements to manage your melasma. It’s important, however, to get a professional diagnosis to know what medications and supplements suit you best.

Pigmentation removal treatment in Singapore

Melasma requires a multifaceted approach. While its appearance is hard to prevent, it is a treatable pigmentation condition. A combination of laser treatments and medication can significantly improve your skin and self-confidence. 

If you're ready to explore professional pigmentation removal treatments tailored to your skin condition, Dr Wan can provide the guidance you need .

Book a consultation today.


  1. Ana Carolina Handel, Luciane Donida Bartoli Miot. (2014). Melasma: a clinical and epidemiological review. An Bras Dermatol.
  2. Jordan V Wang, Mitalee P Christman.(2021). Laser-assisted delivery of tranexamic acid for melasma. J Cosmet Dermatol.

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