Skin
Observ Skin Analysis
- Duration
- 30 mins
- Downtime
- None
From £50
Skin concern
Melasma
Melasma is a hormonally-driven pigmentation condition. It sits deeper than UV damage and does not respond to the same treatments. Identifying the depth before starting is the step most clinics skip.
Understanding the cause
What's happening in your skin
01
Why melasma resists standard pigmentation treatments
Melasma is driven by oestrogen-sensitive melanocytes that produce excess pigment in response to hormonal fluctuation and UV exposure simultaneously. Standard brightening approaches target only one driver.
Most pigmentation responds predictably to IPL and resurfacing. Melasma does not, because it has a hormonal driver that remains active regardless of how much surface pigment is cleared. Oestrogen-sensitive melanocytes in the dermis continue producing excess melanin when triggered by UV or hormonal change, which is why melasma commonly appears or worsens during pregnancy, hormonal contraceptive use, or perimenopause. Treating the surface without addressing the deeper driver produces short-lived results.
02
The depth problem
Melasma presents in three patterns: epidermal (surface), dermal (deep) and mixed. IPL, which works well for sunspots, can worsen dermal and mixed melasma by generating heat in the dermis and stimulating further pigment production.
OBSERV skin analysis uses cross-polarised and UV fluorescence imaging to reveal where pigment sits before any treatment is chosen. Epidermal melasma shows clearly under UV light and responds to superficial acid peels and enzyme exfoliation. Dermal and mixed patterns require a more cautious approach, typically combining gentle resurfacing with topical support. Applying heat-based treatments to dermal melasma is one of the most common reasons the condition worsens after clinic treatment.
03
A maintenance mindset, not a one-off fix
Clinical studies report that melasma recurs in the majority of patients without a consistent maintenance programme. SPF 50+ applied daily is not optional. It is part of the treatment.
Even after significant clearance, melasma will return with continued UV exposure or hormonal change unless a maintenance programme is in place. This includes high-factor SPF every morning, avoidance of heat-generating treatments during active flares, and periodic resurfacing to manage new pigment accumulation. Consultation at The London Road Clinic includes a full maintenance discussion before any course of treatment begins.
Recommended treatments
What we use for melasma
Clinical perspective
Melasma is one of the most mismanaged pigmentation conditions I see. Patients come in after IPL treatment elsewhere and their melasma has actually got worse, which is what happens when heat is applied to dermal or mixed pigmentation. The first thing we do is OBSERV imaging to understand what we are working with. Only then do we build the treatment plan. For most people it is a combination of gentle resurfacing and very disciplined sun protection, not a single treatment.
IPL can worsen melasma Depth determines the plan Maintenance is non-negotiable
In their own words
I'd been dealing with patches across my cheeks for three years and tried everything from high street. The scan showed exactly what was happening and the plan Lydia put together made sense from the first appointment. The improvement has been genuinely significant.
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Common questions
Frequently asked about melasma
Is melasma the same as sunspots?
No. Sunspots are caused by localised UV damage and tend to respond well to IPL and resurfacing treatments. Melasma is a hormonal condition driven by oestrogen-sensitive melanocytes that produce excess pigment in response to both UV and hormonal fluctuation. It often sits deeper in the skin and requires a different treatment approach. The two conditions can coexist, which is why OBSERV imaging before treatment is important.
Why can IPL make melasma worse?
Lumecca IPL works by generating heat within pigmented cells. For superficial UV damage, this is effective. For dermal or mixed melasma, the heat reaches the dermis and stimulates the oestrogen-sensitive melanocytes responsible for the condition, increasing pigment production. This is why a thorough skin assessment identifying the depth and type of pigmentation is essential before any light-based treatment is used.
Can melasma be treated during pregnancy?
Most clinical treatments for melasma are not recommended during pregnancy. Consultation with your clinician is essential before beginning any course of treatment if you are pregnant, breastfeeding, or planning a pregnancy. Hormonal changes during pregnancy are one of the most common triggers for melasma onset and flares.
How long does melasma treatment take?
Visible improvement typically develops over a course of three to six treatments, spaced four to six weeks apart, alongside a consistent home care programme. Results depend on the depth and severity of the melasma and on adherence to the sun protection protocol. Most patients see meaningful clearance within three to four months, with continued improvement through the maintenance phase.
Will melasma come back after treatment?
Melasma is a chronic condition with a high recurrence rate, particularly with UV exposure or hormonal change. Clinical treatment can achieve significant clearance but is not a permanent cure. Consistent SPF 50+ use, avoidance of heat-based treatments during active flares, and maintenance resurfacing are the key factors in keeping the condition controlled long term.
Ready to take the next step?
Book a consultation
Your clinician will assess your skin, review your history and design a treatment plan matched to your specific presentation, not a generic protocol.
Medically reviewed by Dr Shahe Boghossian, Medical Consultant, GMC 5204600 . Last reviewed 21 May 2026.
