What does melasma on the face look like?
Why is melasma different from ordinary pigmentation?
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 durably 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.
The triggers you can and cannot control
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.
Types of melasma: the facial pattern and how deep the pigment sits
Melasma is described in two ways at once: by where the patches sit on the face, and by how deep the pigment lies in the skin. Both matter, because together they shape how quickly a plan can move and which steps are worth taking. Neither can be judged reliably from a selfie, which is why the type is named at examination before any treatment is discussed.
The facial pattern is the part you can see in the mirror. A centrofacial pattern spreads across the forehead, cheeks, nose, upper lip and chin. A malar pattern sits on the cheeks and nose. A mandibular pattern runs along the jawline. Some people also have patches on the forearms, which follow the same biology. The pattern helps to separate melasma from its lookalikes: a symmetrical, soft-edged patch behaves like melasma, while discrete sharp-edged spots suggest sun spots, and speckled blue-grey dots over the cheekbones suggest Hori's naevus.
Depth is the part you cannot see. Under a Wood's lamp and the dermatoscope, pigment in the epidermis shows up with sharper contrast, pigment in the dermis stays blurred and grey-brown, and many faces show a mixed picture. Dermal pigment is held by cells deeper in the skin and clears more slowly, so the honest pace of a plan follows the depth.
| Type | What it looks like | How it is checked | What it means for the plan |
|---|---|---|---|
| Centrofacial pattern | Patches across forehead, cheeks, nose, upper lip and chin | Examination and photographs in standard light | A wider area to protect and treat; trigger control matters more |
| Malar pattern | Patches on the cheeks and nose | Examination; Hori's naevus excluded | Often a more limited area; mimics are common here |
| Mandibular pattern | Patches along the jawline | Examination; post-inflammatory marks excluded | Friction and irritation are reviewed as triggers |
| Epidermal depth | Brown, sharper contrast under the lamp | Wood's lamp and dermoscopy | Topicals and photoprotection tend to show progress sooner |
| Dermal or mixed depth | Grey-brown, blurred edges | Wood's lamp and dermoscopy | A slower, more conservative plan; heat is avoided |
The type is not fixed for life. Patches can spread in pregnancy, lighten with strict protection and return with sun, heat or hormonal change. That is why the plan is reviewed rather than set once, and why the melasma treatment page sets out the option matrix by depth in detail.
What actually works for melasma?
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.
What doesn't work for melasma?
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
How a doctor treats melasma in Singapore, step by step
Melasma is treated by a doctor in stages: diagnosis first, then control of the triggers, then topical and oral medicine where suitable, and gentle energy work once the skin is stable, not before. The order matters more than the device. Starting with a strong laser on a face that has not been diagnosed or protected is the commonest route to rebound darkening, and the reason so many people arrive having tried treatment elsewhere.
Singapore adds two pressures. Most skin here is Fitzpatrick III to V, which forms pigment readily after heat or inflammation, and the ultraviolet index stays high all year and the heat adds to it. A plan that ignores daily light and heat exposure does not hold, whatever is done in clinic.
| Step | What happens | Why it comes at this point |
|---|---|---|
| 1. Diagnosis | Examination with Wood's lamp and dermoscopy; Hori's naevus, sun spots and post-inflammatory marks separated; hormonal medication and pregnancy plans reviewed | Each brown has a different plan, and melasma often coexists with another type |
| 2. Light and heat control | Daily tinted sunscreen with iron oxides for visible light, shade and a hat, and fewer heat triggers such as saunas | Without this, every later step is undone |
| 3. Topical loading | Prescription and skincare agents chosen for the skin, such as hydroquinone in planned courses, tretinoin, azelaic acid or tranexamic acid | Settles pigment production before any energy is considered |
| 4. Oral medicine where suitable | Oral tranexamic acid, considered after clotting risk, smoking and hormonal contraception are reviewed | A prescription option for some; not used where the clotting risk is raised or in pregnancy |
| 5. Gentle energy, if indicated | Conservative work starting with R2 Glow alone, or no laser at all, within the R2T2 protocol | Addresses the inflammatory drive without the heat that triggers rebound |
| 6. Maintenance and review | Photoprotection continues; topicals are stepped down; relapse is planned for | Melasma is controlled rather than cured |
Dr Sin Yong, an aesthetic physician, assesses and treats every patient personally on Orchard Road. Where a patch is changing, raised or unlike the rest, it is examined first and referred for dermatological assessment rather than treated as melasma. Pregnancy and breastfeeding change the plan most: elective laser is deferred and most prescription agents are avoided, so photoprotection becomes the main measure until the plan can resume.
Melasma at home: what you can do yourself, and what needs a doctor
Melasma is managed mostly at home, day to day, with a doctor setting the plan and stepping in where home care cannot reach. What you do every morning matters more than any single clinic visit, because light, heat and friction keep switching the pigment cells back on.
What you can do yourself
- A tinted sunscreen every day, indoors too. Broad-spectrum sunscreens with iron oxides also block visible light, which clear sunscreens let through. In a randomised trial, people with melasma using a tinted sunscreen alongside their cream did better than those using a UV-only sunscreen. Add shade and a hat outdoors; the sunscreen guide for Singapore covers textures and reapplication.
- Gentle brighteners as support. Azelaic acid, niacinamide, vitamin C and short-contact cysteamine are widely used. Reviews find the evidence for over-the-counter products limited, so treat them as maintenance rather than the whole plan.
- Less heat and less rubbing. Saunas, hot yoga, steam facials, scrubs and rough towels all feed melasma.
- Notes on your triggers. A new contraceptive pill, pregnancy or a change of skincare often lines up with a flare. Bring that history to the consultation.
What should not be done at home
Prescription-strength hydroquinone, tretinoin and oral tranexamic acid need a doctor to decide the strength, how long a course runs and who should avoid them, for example in pregnancy or where the clotting risk is raised. Lightening creams from salons or online sellers may contain undeclared steroids or unsafe hydroquinone. Home IPL and laser gadgets add heat to a heat-sensitive condition.
Why Asian skin needs a gentler hand
Most skin in Singapore is Fitzpatrick type III to V, which makes pigment readily after irritation. A routine that stings or peels can leave post-inflammatory hyperpigmentation on top of the melasma, and the two then need separating before anything else is changed. Start one new product at a time and stop anything that burns.
When home care is not enough
See a doctor when patches keep spreading despite a daily tinted sunscreen, when a cream has left the skin red, thin or with visible vessels, or when one spot looks different from the rest. The assessment and staged plan are set out on melasma treatment in Singapore.
Dr Sin Yong’s Viewpoint
Melasma has humbled every aggressive laser ever pointed at it, and it will humble the next one too. I manage it the way the evidence says: light control, topicals, patience, and gentle energy in its supporting role — with maintenance planned from day one. Any clinic promising a melasma cure is promising your relapse.
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