Pigmentationismanaged,notcured.

Melasma is the most frustrating condition we treat, and not because it is hard to improve. It is frustrating because it improves and then returns, often within months, and people conclude that the treatment failed. Usually the treatment worked exactly as it should have. What was missing was the part that comes afterwards.

What is melasma, and how is it different from other dark patches?

Melasma is a pattern of symmetrical brown or grey-brown patches, typically across the cheeks, forehead, upper lip and jaw. It is driven by pigment-producing cells that have become over-reactive — to ultraviolet light, to visible light, to heat, and to hormonal change. That reactivity does not go away when the patch fades.

This matters because several other things look similar and are treated very differently. Post-inflammatory hyperpigmentation is the mark left behind by acne, an injury or a burn, and it usually resolves on its own given time and protection. Sun-induced spots, freckles and certain moles behave differently again. The first job at a consultation is deciding which of these you actually have, because a plan built for the wrong one will not work and can make things worse.

Why does pigmentation come back after treatment?

Because the treatment addresses the pigment that has already been made, while the cells that made it remain sensitised. Remove the trigger and they settle. Leave the trigger in place — daily sun exposure on a Delhi commute, heat, an unaddressed hormonal driver — and they resume, on skin that is now more reactive than it was.

This is why we describe melasma as a condition that is managed rather than cured, and why we would rather say so at the first appointment than have you discover it after paying for a course.

Why sunscreen is the treatment, not the aftercare

If you take one thing from this article, take this: in melasma, daily broad-spectrum sun protection is not a supporting measure. It is the single most effective intervention available, and no in-clinic treatment will hold without it.

It also has to be the right kind. Melasma responds to visible light and heat as well as to ultraviolet, which is why a tinted sunscreen containing iron oxides outperforms a clear one on Indian skin, and why reapplication through the day matters more than the number on the bottle. Indoor light through a window and the heat of a kitchen both count.

What actually works

A plan usually combines several things, sequenced deliberately rather than stacked at once:

• Rigorous, daily photoprotection, including tinted protection against visible light. This is not negotiable and it is where the plan starts.
• Prescribed topical treatment to slow pigment production, used in defined courses and supervised — not indefinitely, and not bought over the counter.
• Chemical peels chosen for melasma and for your skin type, at strengths built up gradually.
• Carefully selected laser or energy treatment, at conservative settings, only once the skin has been prepared and only where it is indicated. In melasma this is a refinement near the end of a plan, never the opening move.
• Investigation of hormonal and medication triggers where the history suggests one, because treating the surface of a problem driven from elsewhere is doing half the job.
• Maintenance. The part everybody skips, and the reason the results of the previous course did not last.

What makes melasma worse

Part of treating pigmentation well is knowing what not to do to it. Melasma is easily aggravated, and several popular approaches aggravate it reliably:

• Aggressive laser settings on unprepared skin. Heat is a trigger for melasma, and a laser is a source of heat. Treated too hard, the patches darken rather than fade.
• Unsupervised skin-lightening creams, particularly those containing potent steroids. They produce a fast early result, then thinned skin, visible vessels and rebound pigmentation that is harder to treat than the original.
• Scrubs, strong exfoliation and frequent facials. Inflammation makes pigment, and irritated skin makes more of it.
• Stopping and starting. Melasma responds to consistency; a plan followed for three weeks in every three months will not hold.

Getting the pigment to fade is the straightforward part. Keeping it faded is the treatment.

How long before I see a change?

Expect the first visible improvement over roughly two to three months, not two to three weeks. Pigment sits at different depths, and the deeper it lies the slower and more partial the response — which is another reason for an honest assessment at the start rather than a promise. What we will tell you at the first appointment is which type you have, roughly how much improvement is realistic, and what the maintenance will involve for as long as you want to hold it.