What is melasma and how does it develop?
Melasma is a form of pigmentation disorder. In melasma, the skin's pigment cells (melanocytes) produce too much melanin in certain areas. Melanin is the pigment responsible for our skin and hair color. It is deposited in the upper layer of the skin (epidermal melasma) or in the deeper dermis (dermal melasma), resulting in irregular, light brown to dark brown discoloration of the skin.
The main causes
Melasma usually develops through an interplay of several factors:
- UV radiation and visible light: Sunlight is the strongest trigger. UV rays stimulate the melanocytes to produce more pigment. Just a few minutes of unprotected sun exposure can be enough to noticeably darken existing spots. High-energy visible light (HEV/blue light) can also intensify melasma.
- Hormonal changes: Hormonal fluctuations play a central role. Women are affected far more often than men, especially during pregnancy (due to rising estrogen and progesterone levels), when taking the contraceptive pill or during hormone replacement therapy.
- Genetic predisposition: People with a family tendency toward hyperpigmentation or a darker skin type have a significantly higher risk.
- Inflammation and irritation: Harsh skincare products, peels or heat exposure (e.g. sauna sessions) can further stimulate the pigment cells
How can melasma be treated?
Melasma is stubborn and tends to keep coming back. That is why treatment is not only about lightening existing spots, but above all about preventing new pigment formation as far as possible and keeping the skin stable in the long term.
1. Strengthen the skin barrier
A healthy, intact skin barrier can help make the skin more resilient to external irritants. This is particularly important with melasma, because irritation and inflammation can further promote pigment formation.
A good skincare routine should therefore not contain as many active ingredients as possible, but rather be carefully balanced: gentle cleansing, sufficient hydration and skin-supporting lipids form the foundation. Actives such as retinoids or other active ingredients can be added in a targeted way, depending on skin condition and tolerance.
What matters is the formulation as a whole and how it works together with the skin.
2. Consistent sun protection
The most important step against melasma is consistent sun protection. UV radiation can stimulate melanin production and intensify existing pigmentation. Visible light can also play a role, especially in more strongly pigmented skin types.
That is why a high broad-spectrum sunscreen should be part of the routine every day and not just in summer or on vacation. With melasma, tinted sunscreens containing iron oxides can also be useful, as they shield against part of the visible light as well.
3. Use active ingredients in a targeted way
Depending on how pronounced the melasma is, medical active ingredients that intervene in melanin formation can also be used. These include, for example, azelaic acid, retinoids, tranexamic acid.
The rule here: more is not automatically better. Overly aggressive treatment can irritate the skin and thereby encourage post-inflammatory pigmentation. Finding the right balance is crucial and should be discussed with a professional.
What can aesthetic medicine contribute?
Melasma can also be managed holistically at the practice. The focus is not necessarily on the most intensive treatment possible. Depending on the skin's condition, gentle peels, selected device-based procedures or individually tailored medical treatments can be used, for example.
The key is to understand the skin first: How sensitive is it? How stable is its barrier? How pronounced is the pigmentation? And which treatment can the skin tolerate without becoming further irritated?
That is why melasma often needs not a single “miracle treatment”, but a long-term concept of consistent sun protection, a stable skin barrier, a steady routine and professional medical treatment.