Melasma is a brown patch that spreads on sun-exposed sites such as the cheekbones, cheeks, and forehead. A spot is finished once it is removed, but melasma overlaps sunlight, hormones, and constitution, and darkens again if care stops. Removal puts protection and topical medicine first, and adds laser toning when needed.
3-line summary
If protection is skipped, the effect of a procedure ends quickly. Block ultraviolet light and visible light together.
The order is broad-spectrum protection → prescription lightening cream → laser toning or pico toning when needed.
Laser is added while protection and medicine are maintained; as intensity and session counts accumulate, white spots are reported.
Why melasma darkens again
Melasma forms when pigment that stains the skin brown is made in excess. Some constitutions are prone to it, and when hormonal changes such as pregnancy or birth-control pills overlap, the patch becomes more distinct. Not only ultraviolet light but also visible light stimulates the same pigment. Inflammation from a strong procedure or dermatitis, and medicines that increase light sensitivity, also darken that site again.
If you receive a procedure without blocking sunlight, the color returns quickly. If only one side is dark or the shape changes rapidly, it may be a patch other than melasma, so that site is distinguished first. Melasma removal is closer to reducing irritation and keeping color light than to wiping it away once.
Removal proceeds in this order
Protection and topical medicine come first; laser is added after. If the order is reversed, color may drop briefly and then rise again after irritation.
| Order | What to do | Points to watch together |
|---|---|---|
| Daily | Broad-spectrum protection, hat and shade | Ultraviolet and visible light. Tinted formulas |
| Prescription | Hydroquinone or combination cream | Irritation, duration of use |
| Procedure | Laser toning or pico toning | Intensity and interval. White spots |
In a trial that used a tinted broad-spectrum sunscreen together with hydroquinone, the melasma score fell further than with a sunscreen that blocks only ultraviolet light. Apply it on cloudy days and by windows as well, and reapply when you sweat. Topical medicines often used are hydroquinone alone or a cream that mixes a retinoid and a mild steroid. Applying it on your own for a long time can leave irritation and pigment, so the prescribed period is followed.
When the response to medicine is slow, a chemical peel is added, and if there is no history of thrombosis, an oral prescription medicine is sometimes reviewed as an adjunct. The daily application habit can be read further in the daily sunscreen use guide and the summer pigmentation prevention guide.
Laser toning and pico toning
Laser toning lightens pigment by splitting a low-output Nd:YAG laser across multiple sessions. Pico toning handles pigment with a shorter pulse. Both are used for melasma, and with laser alone, color often rises again within months. When used together with topical medicine and protection, the response lasts longer, and as session counts increase, reports of white spots increase.
| Item | Laser toning | Pico toning |
|---|---|---|
| Method | Weakly, several times | Short pulse |
| Interval | Several sessions; weekly is common | Split across several sessions |
| Limits | Recurrence; white spots if overdone | Recurrence; same-day erythema and itch |
Erythema and itch are common on the day, and pigment can remain after irritation. Keep protection from the day of the procedure, use a non-irritating cleanser, and postpone saunas and strong exfoliation. The procedure flow can be read in the laser toning guide; the difference between the two devices, in the pico toning vs laser toning comparison. For sun after a procedure, follow the post-treatment sun protection guide; for shared precautions, follow the treatment safety information.
Five things to confirm before a procedure
In one sitting, match whether today's patch is melasma, the sunscreen and medicines you currently use, and prior laser response. Confirm the items below in order.
- □ Have you had this mark distinguished as melasma, or as a sunspot or freckle?
- □ Are you using a sunscreen that blocks not only ultraviolet light but also visible light?
- □ Are you reviewing the name of the topical medicine, how long it is used, and whether irritation remains?
- □ If laser is added, how are intensity, interval, and session count set? Have white spots appeared before?
- □ Have you mentioned pregnancy or breastfeeding, birth-control pills or hormone medicines, and a recent history of strong procedures?
Frequently asked questions
Q1. Does laser make melasma go away?
Melasma is a patch that is lightened and then maintained with protection and medicine. Laser is one step that helps that maintenance.
Q2. Does the procedure hurt?
Stinging and heat remain on the day. Treatment often proceeds after applying a numbing cream, and the degree of pain varies with the device and intensity.
Q3. How many sessions are needed?
It is split across several sessions at low intensity. The interval is set by watching the skin's response, and intensity is not raised to fill a session count.
Q4. Can it be used together with topical medicine?
A plan that uses them together keeps the response longer than a plan that uses laser alone. If irritation stacks on the same day, the medicine is paused for a few days.
Q5. Who should not have it?
Pregnancy and breastfeeding, infection at the treatment site, skin that previously formed white spots after laser, and use of photosensitizing medicines are disclosed before proceeding. Birth-control pills and hormone medicines can also darken melasma, so they are mentioned in advance.
Results, duration, and suitability vary with individual skin condition, age, and lifestyle, and the same outcome cannot be guaranteed.
Procedures may cause temporary redness or swelling, and contraindications may apply, so please confirm these during your consultation.
This article is general information and does not replace individual medical care. Please confirm diagnosis and treatment suited to your condition during a consultation.
Sources
- PMID 35904706 — Literature review of melasma pathogenesis. Verified scope: abstract + PMC full text. No Europe PMC record of retraction or expression of concern. No research funding or author conflict of interest disclosed. This is an existing literature review that organizes sunlight, sex hormones, pregnancy, inflammation, and constitution as overlapping.
- PMID 24313385 — A trial comparing a tinted sunscreen containing iron with a sunscreen that blocks only ultraviolet light, each used together with hydroquinone. Verified scope: abstract. 68 assigned, 61 completed, 8 weeks. The melasma score fell further in the tinted-sunscreen group. The article did not generalize from this single trial. Conflicts of interest outside the abstract could not be confirmed.
- PMID 38099013 — Systematic literature review of topical and oral medicines. Verified scope: abstract + PMC full text. No retraction or expression of concern; no conflict of interest. It organizes hydroquinone, combination cream, and sunscreen first, and laser after. Medicines differ by country.
- PMID 35888655 — Systematic literature review of low-output Nd:YAG laser toning. Verified scope: abstract + PMC full text. No retraction or expression of concern; no external research funding. It notes that white spots remain when cumulative energy is high, and this is why combination is used rather than monotherapy. Study designs vary, so the numbers could not be pooled into one.
- PMID 36533794 — Meta-analysis of low-output Nd:YAG laser toning. Verified scope: abstract. Combination produced a larger score change than monotherapy; the effect decreased over time; and session count and reports of white spots moved together. The full-text original could not be opened in this environment.
Related reading
Sources
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