Dr. Maryam Zamani
29 Aug 2023

Your Guide To Melasma And How To Treat It

What is Melasma?

Many of you may be familiar with my own journey with melasma.  I say journey because melasma is an ongoing pigmentary condition of the skin that waxes and wanes and needs to be managed to keep at bay. This is what you need to know about what melasma is and the ingredients and products that work.

Melasma is a pigmentation condition of the skin that is hormonally regulated and worsens with stress, UV radiation (sun exposure), heat (sauna/steam rooms for instance), and thyroid disorders. There are also certain medications that can also trigger flare-ups. Melasma is most common in skin type 3 and 4 and is seen more among women than men. It is often referred to as the ‘mask of pregnancy’ that can look like a shadow over the upper white lip, or as plaques on the cheeks, chin or forehead. Melasma appears as dark brown patches in dark skin complexions and can appear more tan in colour in lighter skin tones.

How is melasma diagnosed?

Melasma is a clinical diagnosis that is categorised as either epidermal or dermal hyperpigmentation. Epidermal melasma is more superficial, and it lights up in a Wood’s lamp examination. Dermal melasma is deeper and will not light up as much with a Wood’s lamp for that reason.

How to avoid melasma flare-ups?

+ Avoid the sun exposure when possible. Wear a broad spectrum sunscreen to shield skin from UVA and UVB rays. Wear sunglasses, visors and hats that protect the face from the sun.

+ Avoid triggers like heat and stress, which can be difficult to do.

How to manage melasma?

Key ingredients to add to your arsenal: 

  1. Broad spectrum SPF is at the core of preventing melasma or worsening its appearance.
  2. Prescription products: hydroquinone is the gold standard for treating pigmentation. Use this in combination with a prescription retinoid like pigmanorm or with and azelaic acid.  There are varying concentrations that can be used to interfere with the pigmentation pathway and prevent new pigmentation.
  3. Arbutin works similarly to hydroquinone but is not prescription.  It helps to slow down the formation of pigment.
  4. Kojic acid blocks the pigment pathway and prevents tyrosine from converting into melanin.
  5. Liquorice root extract is a skin-lightening agent that can help even out your dark spots.
  6. Topical (or oral) tranexamic acid works to inhibits the melanin synthesis.
  7. Vitamin C will help brighten skin

What can you do in office to speed this process up?

Post summer is the PERFECT time to treat melasma. Skincare is essential and can be used in conjunction with in treatments to accelerate the process.

  • 6 Sessions of monthly microneedling with intradermal or topical Tranexamic Acid
  • MOXI laser to break up existing pigmentation with intradermal or topical tranexamic acid
  • HALO laser to treat deeper dermal pigmentation with the


What worked for me

The hardest part of melasma is that it cannot be permanently treated, and flare ups, particularly after summer can really affect self-esteem and confidence.  The use of topical skincare products has been essential in keeping my melasma at bay, but I spend a LOT of time in a hot, sunny climate in the summer and despite my best efforts, my melasma does return; maybe not as bad as it used to be, but enough to bother me. My first point of contact in September is to combine MOXI with HALO in conjunction with prescription topicals to help even my skin tone immediately.

Melasma is a tricky condition; and affects so many people from pre pregnancy all the way through menopause; don’t be hard on yourself.  There is no magic bullet but with the above, we can get your skin to where it needs to be!

Dr. Maryam Zamani

Treatments to Consider:

Newsletter Signup

To receive information from Dr. Maryam Zamani about new treatments and skin care developments sign up to our newsletter.

Book Consultation

As a leading Oculoplastic Surgeon with special interest in Facial Aesthetics, Dr. Maryam Zamani has garnered a global reputation - both in the US and UK - for her meticulous attention to detail and sought-after techniques for eyes and facial aesthetics.

*We will try to accommodate the times on our follow up.
If you know already, what kind of treatment are you interested in?