Melasma and dark spots: why they appear and what actually works

Of everything I treat, melasma demands the most patience — from me and from you. It's also where people most often arrive disappointed, having already tried three creams, two treatments and something recommended online.

So let's be clear about it.

What it is, and what it isn't

Melasma is a hyperpigmentation that appears in symmetrical areas of the face: cheekbones, forehead, above the lip, sometimes the chin. It isn't the same as an isolated sun spot, and it isn't the dark mark left by a spot (that's post-inflammatory hyperpigmentation, and it's treated differently).

What sets it off is almost always a combination of three things:

• Hormones: pregnancy, contraceptives, hormone treatments. It used to be called "the mask of pregnancy" for a reason.
• Sun and heat: the sun switches it on, but so does heat. That matters here: cooking, hair dryers and midday sun all count.
• Genetic predisposition: some skins simply pigment more easily, especially medium and higher phototypes, which is most of the coast.

Why it "doesn't go away"

Because melasma isn't a mark on the surface: it's a cell that has learned to overproduce pigment and keeps doing it. You can lighten what sits on top, but if the trigger continues — sun, heat, hormones — it comes back.

That's why I never talk about "removing" melasma. I talk about controlling it. And controlled, it looks very good: even skin, without the shadow that makes you reach for foundation every morning.

What works, in order

1. Sun protection, non-negotiable. SPF 50+, mineral or tinted, every day, reapplied. Without this, everything else is money lost. I repeat it because it's literal: 70 % of the result sits here.

2. Pigment-corrector actives at home. Tranexamic acid, niacinamide, azelaic acid or vitamin C, depending on what your skin tolerates. Used consistently over months, not days.

3. Progressive chemical peels. Low concentrations, spaced sessions. With melasma, going in hard from the start backfires: inflame the skin and melasma answers by pigmenting more. Less is more.

4. Mesotherapy with brightening actives. It delivers the active exactly to the depth where the problem sits.

5. Maintenance, always. Once we reach the tone we were aiming for, nothing stops abruptly. We lower the intensity and hold it.

What makes it worse

• Aggressive or poorly judged peels.
• Badly indicated laser. In melasma, too much heat can rebound worse than before.
• Over-the-counter hydroquinone creams used without supervision, very common on the informal market. Misused, they cause ochronosis — a permanent blue-grey discolouration that genuinely is hard to reverse.
• Scratching, over-exfoliating, or dropping the sunscreen "because it's looking better now".

How long it takes

With consistency, the first visible changes appear between weeks six and eight. A solid result takes three to six months. It isn't fast, and I'd rather tell you that up front than sell you an expectation that won't hold.

I'd rather you leave knowing it's six months than come back in three weeks disappointed because I promised you one.

How we start

With an assessment. I look at the type of pigmentation, its depth, your phototype and what you've used before — that last part matters, because a lot of skin arrives already sensitised. From there comes a plan: what we do in the room, and what you maintain at home.

Message me on WhatsApp and we'll book the assessment. And if you're pregnant or breastfeeding, tell me straight away: some actives are off the table, but we still have plenty to work with.

• Pigmentation
• Melasma
• Facial treatments