Melasma is a chronic, relapsing pigment disorder — symmetrical soft-edged brown patches across the cheeks, forehead or upper lip. It is not simple sun damage: hormones, visible light, blood vessels and dermal inflammation all feed it, which is why it behaves unlike any other brown patch and why the honest goal is control, not cure.
WhatsApp Dr Sin Yong →Current pathogenesis reviews describe melasma as far more than a melanin problem: genetically susceptible skin under chronic light exposure develops overactive melanocytes, but also an altered basement membrane, increased vascularity and low-grade dermal inflammation — the whole neighbourhood participates, not just the pigment cells [1]. This is why melasma relapses after treatments that would permanently clear a sunspot, and why heat and aggressive lasers can make it rebound darker. Hormones layer on top: pregnancy and hormonal medication are classic triggers, which is also why melasma so often begins in a woman's 30s.
You cannot choose your genetics or undo a pregnancy trigger. You can control light — and the evidence here is specific: visible light, not only UV, drives melasma pigmentation, which means window glass and indoor exposure count, and standard clear sunscreens are incomplete protection. Tinted sunscreens containing iron oxides block the visible wavelengths implicated [1,3]. Heat is the other underrated trigger — saunas, steam rooms, aggressive treatments. A melasma plan that ignores light and heat management is a plan built to fail.
The network meta-analysis across melasma treatments ranks combination approaches highest: photoprotection plus evidence-based topicals (with triple-combination creams and related regimens leading), with oral and procedural options — including conservative low-fluence laser toning — as adjuncts rather than first weapons [2,3]. Aggressive monotherapy lasers rank poorly precisely because rebound is a documented outcome. Dr Sin Yong's staged protocol on the melasma treatment page follows this hierarchy: diagnose first (see which brown is yours — melasma coexisting with other pigment types is common), stabilise with topicals and photoprotection, then add gentle energy-based work such as laser toning where indicated, with maintenance planned from day one.
One strong laser to “remove it” — melasma punishes heat and haste with rebound pigmentation. Bleaching creams from unregulated sources — some contain unlisted steroids or high-dose hydroquinone that damage skin with long-term unsupervised use. Scrubbing — friction is itself a melasma trigger. And any clinic promising a cure — the literature is unambiguous that melasma is a chronic relapsing condition; a promise of cure is a promise of your disappointment.
“Melasma punishes aggression — the laser that clears a sunspot in one session can hand a melasma patient a darker patch than they started with.”
— Dr Sin Yong
Because the disease is still there — overactive melanocytes, vascular changes and light sensitivity persist under cleared skin. Clearing is a state to be maintained, not a cure that ends care.
Pregnancy is a classic trigger — the hormonal surge activates susceptible pigment cells. Some post-pregnancy melasma fades; patches that persist months after delivery usually need active management.
Yes — visible light, including from bright indoor environments and through windows, measurably stimulates melasma pigmentation. This is why iron-oxide tinted sunscreen is standard melasma advice.
Gentle, low-energy laser protocols have a supporting role within a combination plan. High-energy 'removal' attempts are the classic way melasma gets worse — device, settings and sequence matter more than the word 'laser'.
Genetic susceptibility plus your particular mix of hormones and light exposure. Fitzpatrick III–V skin — most Singaporean skin — carries the highest risk.
Photoprotection stops the fuelling but rarely erases established pigment alone. It is the foundation every other treatment stands on — necessary, seldom sufficient.