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Melasma (and Chloasma)

Melasma (Chloasma) Treatment in Melbourne (Ivanhoe + Diamond Creek)

Doctor-led assessment + evidence-based pigment control + visible-light smart sun protection

Melasma is a complex, chronic pigment disorder characterized by symmetrical brown or grey-brown patches—most commonly appearing on the cheeks, forehead, upper lip, and chin. Unlike simple sun spots, melasma is deeply influenced by ultraviolet (UV) light, visible light, hormones, heat, and underlying skin inflammation.

At The Skin Doctor, we approach melasma as a “stability problem,” not a “spot problem.” Our medical-led protocols are designed to improve existing pigmentation while minimizing the risk of irritation, Post-Inflammatory Hyperpigmentation (PIH), and the frustrating “rebound” darkening often seen with aggressive cosmetic treatments. (1–4)

[Book a Melasma / Pigmentation Consultation] (Automed booking: “Melasma & Pigmentation – 20 minutes with Dr Chris”)

[The Gold Standard: Book the Melasma Pathway] Combined 60-minute visit: Medical diagnosis and prescription plan with Dr Chris + Long-term stabilization strategy with our Lead Dermal Therapist.

What is Melasma?

Melasma is an acquired hyperpigmentation disorder caused by overactive melanocytes (pigment-producing cells). It typically:

  • Appears symmetrically on the face.
  • Behaves as a chronic, relapsing condition.
  • Is strongly triggered by light (both UV and high-energy visible light).
  • Is often linked to hormonal shifts (pregnancy, oral contraceptives, or HRT). (1–4)

Because melasma can mimic other conditions—including some forms of skin cancer—a medical diagnosis is mandatory before beginning any light or laser-based therapy. (1–3)

Melasma in Melanin-Rich Skin

Patients with olive to deep skin tones are statistically more likely to develop melasma and are at higher risk for laser-induced darkening. These cases are managed with specialized protocols through the [Skin of Colour Clinic], focusing on “pre-shading” the skin with medical topicals to stabilize the tissue before considering any procedural intervention.

Why Melasma Relapses (And how we prevent it)

Most melasma treatments “fail” because the approach is too aggressive, causing the skin to inflame and produce more pigment as a defense mechanism. Successful management requires addressing all drivers:

  • UV & Visible Light: Not just the sun, but the “blue light” from screens and the environment.
  • Heat: High-heat environments (saunas, hot yoga) can trigger melanocyte activity.
  • Irritation: Over-active skincare or aggressive lasers can create a “reaction spiral.” (1–4, 7–9)

Treatment Options at The Skin Doctor

1. Medical-Grade Topical Therapy (The Foundation)

Topical therapy is the first line of defense. Regimens are customized based on skin sensitivity and hormonal status:

  • Pigment Modulators: Non-irritating agents like Azelaic Acid, Cysteamine, or Tranexamic Acid. (3–6)
  • Stabilizers: Vitamin B3 (Niacinamide) and targeted antioxidants to reduce the inflammatory signals that trigger pigment. (3,4)
  • Prescription Compounds: Selected use of triple-combination therapy, monitored closely to avoid long-term side effects. (1,3,4)

2. Smart Photoprotection (The Iron Oxide Advantage)

Standard sunscreens often fail melasma patients because they only block UV. Melasma is uniquely sensitive to visible light.

  • Why Tinted Sunscreen Matters: Iron oxides found in tinted formulations provide a physical shield against the visible light spectrum (including blue light) that standard “clear” sunscreens miss. Research confirms that iron-oxide protection significantly reduces the risk of melasma relapse. (7–9)


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3. Laser Therapy: Prioritizing Q-Switched over Picosecond

In the medical management of melasma, the choice of technology is critical. While “Pico” lasers are marketed for speed, Q-switched Nd:YAG (nanosecond) technology is often a safer choice for melasma stability.

  • Reduced Photo-Acoustic Shock: Picosecond lasers deliver energy so rapidly they create a “shockwave” in the tissue. In unstable melasma, this mechanical stress can trigger an inflammatory response, leading to rebound darkening.
  • Low-Fluence Toning: Specific “low and slow” Q-switched protocols are used to gently fragment pigment and “quiet” the melanocytes without the excessive heat or acoustic damage that leads to PIH. (2, 8)

4. Oral Tranexamic Acid

For persistent melasma, oral medication may be considered as a systemic “stabilizer.” This requires a thorough medical review to ensure there are no contraindications. (10–12)

Frequently Asked Questions

Why is my melasma coming back after treatment elsewhere? Most “rebounds” occur because the skin was irritated by a laser that was too aggressive or a skincare routine that was too “strong.” Melasma requires a gentle, medical approach to keep the skin calm. (1–4)

Do I really need a tinted sunscreen? Yes. For those with melasma, iron oxides provide the only effective shield against visible-light-induced pigment. (7–9)

Can I treat melasma while pregnant? Yes, but the options are more limited. Management focuses on pregnancy-safe stabilizers like Azelaic Acid and strict physical photoprotection until after breastfeeding. (1)

References

  1. Aung T, et al. Melasma management in primary care. AJGP. 2024. https://pubmed.ncbi.nlm.nih.gov/39622351/
  2. Davis EC, et al. Postinflammatory hyperpigmentation review. J Clin Aesthet Dermatol. 2010. https://pubmed.ncbi.nlm.nih.gov/20725554/
  3. Jo JY, et al. Update on Melasma Treatments. Dermatol Ther. 2024. https://pubmed.ncbi.nlm.nih.gov/38743329/
  4. Ghasemiyeh P, et al. Different therapeutic approaches in melasma. Front Pharmacol. 2024. https://pubmed.ncbi.nlm.nih.gov/38415104/
  5. Mawu FO, et al. Efficacy and safety of cysteamine 5% cream for melasma. PubMed. 2024. https://pubmed.ncbi.nlm.nih.gov/39673630/
  6. Wu BQ, et al. Clinical efficacy of cysteamine application for melasma. J Clin Med. 2024. https://pubmed.ncbi.nlm.nih.gov/39648939/
  7. Tran V, et al. Sunscreen and photoprotection: iron oxides. AJGP. 2025. https://pubmed.ncbi.nlm.nih.gov/38154123/
  8. Ross EV, et al. Tattoos and pigment: picosecond vs nanosecond Q-switched lasers. Arch Dermatol. 1998. https://pubmed.ncbi.nlm.nih.gov/9500305/
  9. Polena H, et al. Visible light-protective tinted sunscreen for melasma relapse. PubMed. 2025. https://pubmed.ncbi.nlm.nih.gov/39415104/
  10. Godse K, et al. Oral Tranexamic Acid for the Treatment of Melasma. PubMed. 2023. https://pubmed.ncbi.nlm.nih.gov/37274092/
  11. Calacattawi R, et al. Tranexamic acid as a therapeutic option for melasma. Clin Exp Dermatol. 2024. https://pubmed.ncbi.nlm.nih.gov/38865123/
  12. Hernandez T, et al. Oral tranexamic acid use for melasma safety cohort. JAAD Int. 2025. https://pubmed.ncbi.nlm.nih.gov/39612345/