Melasma (chloasma) — why the usual methods for pigmentation marks fail here

Brown, diffuse patches on the cheeks, the forehead or above the upper lip. Symmetrical — almost mirror-like on both sides of the face. In summer they darken, in winter they fade a little, but they do not disappear. The whitening cream from the drugstore did nothing, and after the holidays it is worse than before.

If this description sounds familiar, you probably do not have "ordinary pigmentation marks" but melasma — also called chloasma. And that distinction changes everything, because melasma is treated differently.

How melasma differs from ordinary pigmentation marks

A typical pigmentation mark — after the sun, after acne, after an injury — is a single patch in the place where the skin went through a specific event. It has a clear cause and usually responds well to brightening treatments.

Melasma is something else: a chronic disorder of the work of the melanocytes, that is, of the cells that produce pigment — and not only of them. The changes also involve the dermis: a damaged border between the epidermis and the dermis, and an expanded network of fine vessels. That is largely why quietening the melanocytes alone does not close the matter, and why the patches have a tendency to come back. The characteristic picture is extensive, symmetrical patches on the cheeks, the forehead, the nose and above the upper lip. Two factors drive it:

• hormones — which is why it often appears in pregnancy (the "pregnancy mask"), with hormonal contraception or with hormone therapy for the menopause,
• UV radiation — every exposure to the sun stimulates the overactive melanocytes anew. A walk on a sunny day without sunscreen is enough.

That is why melasma "comes back after the holidays" and why it mainly affects women between the ages of 20 and 50.

If the patches appeared during pregnancy, or if you are breastfeeding — we will wait with treatment. Some lightening products are contraindicated at that time, and in many women the discoloration fades on its own after childbirth. During this period we do one thing, but consistently: we protect the skin from the sun and from visible light. We return to therapy when it is safe and has a chance of giving a lasting result.

Why a drugstore cream and a single treatment will not be enough

Brightening cosmetics act on the surface, while the problem of melasma sits in the overactivity of the pigment cells — without calming that overactivity the patches rebuild themselves from within.

There is a second trap too: aggressive, one-off treatments can make melasma worse. Strong irritation of the skin can stimulate the melanocytes even more — the result is sometimes post-inflammatory pigmentation at the treated site. That is why an experienced doctor does not start treating chloasma with a powerful laser.

What really works

In our clinics the basis of treatment is depigmentation therapy: a protocol spread over time that combines an in-office treatment (a mask with a high concentration of ingredients that inhibit pigment production) with several months of home care that maintains the effect. It works on the cause — it calms the overactive melanocytes — and not only exfoliates what is visible.

In our clinics we run it as part of depigmentation therapy; the doctor decides on eligibility and the plan. The therapy costs 1950 zł.

The second, non-negotiable element is photoprotection: an SPF 50+ filter every day, all year round, including in winter and on cloudy days. Without that, every depigmentation therapy is work that can be burned away in one go — literally.

The best moment to start is autumn and winter — less sun means a calmer course of the therapy and a lower risk of recurrence while it is under way.

And one clarification that makes a difference in melasma. A high SPF alone is not enough, because it describes protection against UVB radiation, while the patches are also stimulated by visible light. That is why we recommend tinted sunscreens containing iron oxides — it is the pigment that blocks visible light. In studies, a sunscreen protecting against UV and visible light gave a clearly better lightening effect than one protecting against UV alone. We will choose the specific product to suit your skin tone at the consultation.

Melasma is a marathon, not a sprint — and we say so honestly

Melasma cannot be "removed once and for all" — the tendency remains. What can be done is to bring the skin to an even tone and maintain that state, by combining the therapy, home care and consistent sun protection. Patients who know this rule from the start are satisfied with the results; the disappointed ones are those who were promised a miracle after a single treatment.

First step: show the patches to a doctor. Telling melasma apart from other pigmentation changes — including those that require diagnostic work-up — takes a few minutes, and it decides the whole path of treatment.