Melasma is the most misunderstood form of pigmentation we see. It is not sun damage, it does not respond to the same treatments, and treating it the wrong way reliably makes it worse. This page explains what it actually is, why it behaves the way it does, and what genuinely helps.
What melasma is
Melasma appears as brown or greyish-brown patches, usually symmetrical, across the cheeks, forehead, upper lip and bridge of the nose. It is far more common in women, and it is driven by a combination of hormones and ultraviolet light rather than by sun alone.
That hormonal component is what separates it from ordinary sun damage. Pregnancy, the combined pill, hormone treatments and thyroid changes can all trigger or worsen it — which is why it is sometimes called the “mask of pregnancy”.
Melasma versus sun damage — and why it matters
Sun spots and age spots are discrete, well-defined brown marks. Melasma is diffuse and patchy, with soft edges, and it is usually symmetrical across both sides of the face.
The distinction is not academic. Sun damage responds well to IPL laser skin rejuvenation, which targets pigment with light and heat. Melasma often reacts badly to exactly that — heat is itself a trigger, and aggressive light-based treatment can leave the pigmentation darker than it started.
Melasma also sits at different depths. Superficial (epidermal) melasma responds far better than deeper (dermal) melasma, and mixed patterns are common. A VISIA skin analysis photographs pigment beneath the surface as well as on it, which is how we tell what we are dealing with before recommending anything.
What triggers melasma
- Ultraviolet light — the single biggest driver, and it does not take strong sun. Daylight through cloud is enough.
- Hormones — pregnancy, the combined oral contraceptive pill, HRT and thyroid conditions.
- Heat — independent of UV. Saunas, hot yoga and even aggressive facials can flare it.
- Visible light — including screens and indoor lighting, which is why iron-oxide tinted sunscreens outperform clear ones for melasma.
- Skin trauma — over-exfoliation and harsh treatments can worsen the underlying inflammation.
How we treat melasma at Amara
Our primary treatment for melasma is Cosmelan, a professional depigmentation protocol that works by interrupting melanin production rather than destroying pigment with heat or light. Because it does not rely on light, it is safe across all skin tones — including deeper phototypes, where laser carries a genuine risk of making pigmentation worse.
It is a four-phase course: an intensive mask applied in clinic and worn for 8 to 12 hours, then a home-care regimen over roughly six months that does most of the work. Full detail, including price and downtime, is on our Cosmelan page.
Where pigmentation turns out to be sun damage rather than melasma — or a mixture, which is common — we may use IPL for the sun-damaged component. Our pigmentation treatment page covers how we decide, and our guide to melasma and freckle laser treatments goes into the laser side in more detail.
What does not work
Melasma has a long history of being treated badly, so it is worth being direct about it.
Aggressive laser resurfacing, strong heat-based devices and over-enthusiastic peels can all worsen melasma. So can chasing it with ever-stronger products at home. Hydroquinone works but is not a long-term solution and should be supervised. And no treatment holds without daily sun protection — without SPF, every approach fails eventually.
Will it come back?
It can. Melasma is managed rather than cured, because the things that drive it — hormones and light — do not stop after treatment. What a good course does is clear the existing pigment and give you a maintenance routine that keeps it under control.
Realistic expectation: significant, visible improvement that holds for a year or more with daily SPF and maintenance, rather than a permanent cure. Anyone promising otherwise is overselling it.
Common questions
Is melasma dangerous? No. It is a cosmetic concern with no health risk, though it can be distressing.
Will it fade on its own after pregnancy? Sometimes, over months. If it has not cleared within a year, it is unlikely to resolve without treatment.
Can I treat melasma with laser? Cautiously and selectively, and it is not our first choice. Heat is a trigger, so light-based treatment can worsen it. We assess the pattern and depth before considering it.
What sunscreen should I use? A high-factor mineral or tinted sunscreen containing iron oxides, which block visible light as well as UV, worn daily and year-round.
Start with a skin analysis
Melasma is treatable, but only once you know which type and depth you are dealing with — superficial melasma responds far better than deep, and mixed patterns are common. A VISIA skin analysis maps pigment below the surface as well as on it, so we are not guessing.
Book a VISIA skin analysis as your first step, or read more about Cosmelan treatment in Ireland.
