Dark patches (melasma)
Controlled, not cleared. The plan that holds it, and the treatments that make it darker.
Soft-edged brown or grey-brown patches on both cheeks, the forehead, the upper lip or the jaw, usually in a woman between her twenties and fifties, are melasma. It deepens in summer, often starts with pregnancy or the pill, and is commoner in olive, Middle Eastern, South Asian and East Asian skin.
The honest position first: melasma is managed, not cleared. It is held down with daily tinted sunscreen, skincare, a prescription cream used at night, and in some people a prescription tablet, all discussed face to face. Heat and light drive it, so IPL and most lasers can make it worse, sometimes months later, and we do not use them on it. This page explains why, and what we do instead.
What causes it
Pigment cells in the patches are over-active and respond to three things: ultraviolet light, visible light (the ordinary daylight that comes through windows and that normal sunscreen does not block), and hormones. Pregnancy, the combined pill, the implant, the coil and HRT all set it off or deepen it. Heat on its own, from a sauna, a hot kitchen or a hot laser, darkens it too. Perfumed products on the face and rubbing can add to it. Family history is common.
Depth matters for what will work. Pigment sitting in the top layer of skin responds to creams and gentle peels. Pigment that has dropped into the deeper layer looks more grey than brown and barely responds to anything. Most people have a mix, which is why the result is improvement rather than a clean slate.
What actually treats it
Sunscreen is the treatment itself, and everything else is added to it. A tinted SPF 50 with iron oxides, every day of the year, because the tint is what blocks visible light; an untinted sunscreen leaves that door open. A hat in summer.
The most effective cream is a prescription lightening cream used at night in courses of a few months, then stepped down. A combined prescription cream with three ingredients is used in the same way for short courses. For stubborn melasma a prescription tablet taken for three to six months is an option, off-label, and not for anyone with a personal or family history of blood clots, among other exclusions. We cannot name any of these online. If one is right for you, we say so at a face-to-face consultation and prescribe or refer; your GP may also help.
Non-prescription skincare does real work in between courses: azelaic acid at cosmetic strength, a retinol at night, vitamin C, and newer lightening ingredients. Expect the first change at 8 to 12 weeks. In pregnancy and breastfeeding the plan is azelaic acid at cosmetic strength and sunscreen only.
In clinic, the fit is narrow and we keep it that way. A course of superficial chemical peels, after 4 to 8 weeks of skincare priming, lifts surface pigment and speeds the creams along. On skin types IV and above we test patch first. Our pigmentation treatment page sets out the other pigment types and prices, and our pigmentation page explains how to tell melasma from sun spots and the marks left after spots.
Skin of colour carries the highest melasma rates and the highest risk of a peel or light treatment leaving new dark marks. That is why the plan for darker skin leans on creams and sunscreen, with any peel done gently, test patched and spaced out.
When to see your GP
Most melasma needs no GP visit, but some things that look like melasma are not. See your GP, and we will write to them, if the pigment is on one side only with a grey-blue tone or colour on the white of the eye; if a single patch is irregular, changing or growing, especially after 50; if you have darkening of the skin with pigment inside the mouth or new tiredness; or if you have ever used a cream from abroad or an unlabelled lightening cream, because some contain steroids or mercury and the skin needs checking before any treatment.
What we will not do
We will not treat active melasma with IPL, laser, microneedling or HIFU. Heat and inflammation drive rebound darkening and a more resistant patch, sometimes months after the session. We will not promise to clear it: melasma is reduced and held, and it can return every summer. Anyone offering to clear your melasma in a few sessions is selling you something.
Skincare at home
Morning: a gentle cleanser, vitamin C serum, then a tinted mineral SPF 50, reapplied if you are out. Evening: cleanser, then a retinol or azelaic acid at cosmetic strength, with a plain moisturiser. Do not use retinol or any retinoid if you are pregnant, planning a pregnancy or breastfeeding. No scrubs, no exfoliating mitts, nothing perfumed on the face.
From the Obagi range we stock: Obagi Sun Shield Tint Warm SPF50 85g or Obagi Sun Shield Tint Cool SPF50 85g, the tinted sunscreens that matter most here; Obagi Professional-C 15% Serum 30ml; Obagi Nu-Derm 3 Clear Fx 57g and Obagi Nu-Derm 5 Blend Fx 57g, the non-prescription lightening pair, or the full Obagi Nu-Derm Skin Transformation System Fx Normal to Oily or Normal to Dry; Obagi Retinol 0.5 28g to begin with; SUZANObagiMD Claribright Radiance Brightening Lotion 50g. The prescription cream is discussed in clinic, never named here.
Common questions
Can melasma be cleared for good?
No. It is controlled. Sunscreen, skincare and a prescription cream reduce it, and it is held at that level with daily sunscreen for life. It can come back in summer or with a change in hormones.
Will laser or IPL get rid of melasma?
Usually the opposite. Heat and light can deepen melasma and make it harder to treat, sometimes months later. We do not use IPL, laser, microneedling or HIFU on active melasma. The plan is creams, sunscreen and gentle peels.
Is there a prescription treatment for melasma?
Yes: a prescription cream used at night in courses, and for some people a prescription tablet taken for a few months. We cannot name or price them online; they are discussed at a face-to-face consultation after your skin has been assessed.
How long until I see a change?
With a prescription cream and daily tinted sunscreen, the first change is usually at 8 to 12 weeks. Skincare alone takes longer. Results vary and cannot be guaranteed.
Does the pill cause melasma?
It can trigger it or deepen it, as can the implant, the coil, HRT and pregnancy. Stopping does not always clear it. Tell us about any hormonal contraception or HRT at your consultation.
Can I treat melasma while pregnant or breastfeeding?
Sunscreen and azelaic acid at cosmetic strength, yes. Retinoids, the prescription cream, the combined cream and the tablet are not used in pregnancy or breastfeeding. Most pregnancy melasma fades in the months after delivery.
Why does normal sunscreen not stop it?
Standard SPF blocks ultraviolet but not visible light, which also drives melasma. A tinted sunscreen with iron oxides blocks both, which is why we ask for tint.
Is a chemical peel good for melasma?
A gentle superficial peel course can help surface melasma once the skin has been primed with skincare for 4 to 8 weeks. Deeper peels and any peel done without priming risk making it darker, more so in darker skin, so we test patch first.
Related treatments
Book a free consultation. Or message us on WhatsApp: 077 21 400 600.
Nova Beauty Clinic is in East Finchley, three minutes on foot from East Finchley station on the Northern line, with a car park next door. Melasma brings us clients from Hampstead, Highgate, Muswell Hill and Finchley, and from Hampstead Garden Suburb, Golders Green, Crouch End and Barnet.
This page is general information, not medical advice. What suits you depends on your own skin, health and history, which we go through at a free consultation before anything is booked.