Melasma
Specialist assessment and treatment for melasma
At Midland Skin, we offer consultant dermatologist assessment and treatment for melasma for patients from Birmingham, Solihull, Coventry, Wolverhampton, Worcester and across the Midlands.
Quick Facts about melasma
Best for
Persistent facial pigmentation
Appointment
Initial dermatology assessment
Treatment
Skincare, prescription ± laser
Symptoms
Symmetrical brown patches
Provider
Consultant dermatologist
Price
See below
What is melasma?
Melasma is a common pigmentation condition that causes flat, irregular brown or grey-brown patches, most often on the face. It commonly affects the cheeks, forehead, upper lip, nose and chin and usually appears on both sides of the face.
It is sometimes called chloasma or the “mask of pregnancy”. Although it is more common in women and people who tan readily or have naturally brown skin, melasma can affect any skin tone and can also occur in men.
Melasma is not an infection, is not contagious and is not caused by an allergy. It is not cancerous and will not develop into skin cancer. It does not usually itch or hurt, but its visibility can have a significant effect on confidence and quality of life.
When should I see a dermatologist for melasma?
Specialist assessment is particularly worthwhile when:
- you are not sure whether the pigmentation is melasma or another condition
- the pigmentation is persistent, becoming more noticeable or repeatedly returning
- skincare or treatment you have already tried has not helped
- pigmentation has worsened following a peel, laser or skin-lightening product
- you are considering prescription skin-lightening treatment or oral medication
- you want to know whether laser treatment is appropriate for your skin
- you need a longer-term plan for controlling recurrent melasma
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Why getting the diagnosis right matters
Not all facial pigmentation is melasma. Post-inflammatory hyperpigmentation, sun spots, pigmentation caused by medication, and other acquired pigmentary conditions can sometimes look similar.
Pigmentation caused by prolonged or inappropriate use of hydroquinone can also be mistaken for worsening melasma. Different pigmentary conditions respond differently to treatment, and a peel or laser that is appropriate for one condition may worsen another.
Melasma is normally diagnosed by examining the skin and reviewing its history. A dermatoscope or Wood’s lamp may sometimes be used to examine the pigmentation more closely. Blood tests are not routinely required, and a biopsy is considered when the diagnosis remains uncertain.
Treatment pathway
Initial dermatology assessment
You meet with a dermatologist who examines the pigmentation and reviews when it started, possible hormonal or environmental triggers, your skincare, relevant medication and treatments you have already tried.
Care plan
An individual treatment plan is discussed. This may include photoprotection, skincare changes, prescription topical treatment, oral medication or carefully selected laser treatment.
Review consultation
A review consultation is required to assess your response, check for irritation or other adverse effects and decide whether treatment should be continued, changed, paused or moved into a maintenance phase.
What causes melasma?
Melasma develops when pigment-producing cells in the skin produce too much melanin. There is usually no single cause, and several factors may contribute.
Recognised associations and aggravating factors include:
- ultraviolet light from sunlight and sunbeds
- visible light
- pregnancy
- hormonal contraception and hormone replacement therapy
- a family susceptibility to melasma
Melasma can be more common within families, but it is not inherited in a simple or predictable way.
Some people notice melasma during pregnancy or after starting hormonal medication. Do not stop prescribed contraception, HRT or other medication without discussing this with the appropriate clinician.
Why is sun protection so important?
Exposure to ultraviolet and visible light can darken existing melasma and contribute to recurrence after treatment. Effective photoprotection is therefore part of treatment rather than simply general skincare advice.
This will usually include:
- broad-spectrum SPF 50+ sunscreen with high UVA protection
- a tinted sunscreen containing iron oxides to provide additional protection from visible light
- reapplying sunscreen when outdoors
- wearing a broad-brimmed hat and seeking shade
- avoiding sunbeds
- avoiding irritating skincare that may inflame the skin
Photoprotection needs to continue after the pigmentation improves. Without it, other treatments are less likely to provide lasting control.
How is melasma treated at Midland Skin?
There is currently no cure for melasma. Treatment aims to lighten and control the pigmentation, reduce further darkening and establish a manageable maintenance routine.
No treatment can guarantee improvement. Some patients obtain worthwhile lightening, while others see only a small change or no meaningful response. Occasionally, irritation or a procedure can make pigmentation darker.
Treatment is selected according to your diagnosis, skin tone, depth and distribution of pigmentation, previous treatment and risk of post-inflammatory hyperpigmentation.
Skincare and topical treatment
A gentle skincare routine and consistent photoprotection form the foundation of treatment.
Prescription skin-lightening programmes may be considered where appropriate. These can include treatments containing hydroquinone, a retinoid or a combination of active ingredients. Products containing these ingredients require appropriate medical supervision because they can cause irritation and should not necessarily be used continuously.
Midland Skin may also recommend non-hydroquinone skin-lightening ingredients that may be used as an alternative or as part of a longer-term treatment plan.
The treatment selected for you will depend on your skin, previous response and tolerance. Being assessed does not guarantee that a particular product or prescription will be recommended.
Oral treatment
Oral tranexamic acid may be considered for selected patients, usually alongside topical treatment and photoprotection.
Tranexamic acid is not licensed specifically for melasma and is not suitable for everyone. Your medical history, medication and risk factors for blood clots must be reviewed before it can be prescribed.
Laser toning
Laser toning and the Pigmentation Laser Programme may be considered for selected patients. Treatment usually involves a planned course rather than a single session and is generally used alongside photoprotection and topical treatment.
Vascular laser
Melasma can sometimes have a vascular component, with increased redness or visible superficial blood vessels within the affected skin.
In selected patients, vascular laser may be incorporated into the treatment plan to address this component. It does not remove the underlying tendency to melasma and does not guarantee an improvement in pigmentation.
Can melasma be cured?
No. There is currently no permanent cure for melasma.
Treatment may lighten and control the pigmentation, but response varies considerably. Some patients achieve worthwhile improvement, some achieve only partial improvement, and some do not respond. Treatment can occasionally cause irritation or make the pigmentation darker.
Even after a good response, melasma commonly returns, particularly following sun exposure or when hormonal triggers remain. Maintenance skincare, photoprotection and further courses of treatment may therefore be needed.
Melasma that develops during pregnancy may fade during the months after delivery, although it can persist or return during a later pregnancy.
Your dermatology appointments: FAQs
Who will assess me?
You will be assessed by a dermatologist who will examine the pigmentation and review your skin history, skincare, medication, hormonal factors and previous treatment.
Will I receive a prescription at my first appointment?
A prescription may be provided when the diagnosis is sufficiently clear and prescription treatment is appropriate.
What should I bring to my appointment?
Please bring or photograph the names of:
- skincare products you currently use
- prescribed or non-prescribed skin-lightening products
- previous treatments such as peels, microneedling or laser
- relevant medication, contraception or HRT
Earlier photographs showing how the pigmentation has changed can also be helpful. Please attend without foundation or makeup over the affected areas.
Can melasma be treated during pregnancy or breastfeeding?
Some treatments used for melasma are unsuitable during pregnancy or breastfeeding. In particular, hydroquinone and topical retinoids should be avoided during pregnancy.
Assessment may still be helpful, but management may initially concentrate on gentle skincare and photoprotection, with other treatment deferred where appropriate.
Why is a review consultation required?
Your dermatologist will assess whether the pigmentation has improved, remained unchanged or worsened and decide whether treatment should be continued, changed, paused or moved into maintenance.
Why choose Midland Skin for melasma treatment?
Facial pigmentation does not always have a single cause, and treatment that is poorly matched to the diagnosis or skin tone can be ineffective or make pigmentation worse.
Midland Skin provides consultant dermatologist assessment, access to prescription treatment and a range of laser technologies. This allows medical treatment, skincare and procedures to be considered together rather than offering laser or a skincare package without first establishing whether it is appropriate.
The required review also allows the response and diagnosis to be reconsidered when treatment does not work as expected.
Book in with us
Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
Fees
Melasma Show pricing
Book ConsultationInitial dermatology assessment
Up to 25 minutes
Review consultation
Standard, up to 20 minutes
Bespoke prescription skin cream (30g)
Laser toning – Course of 5, face or neck
References used for this article
- British Association of Dermatologists. Melasma: patient information leaflet. Updated June 2024.
- DermNet. Melasma. Updated December 2025.
- Gan C, Rodrigues M. An update on new and existing treatments for the management of melasma. Am J Clin Dermatol. 2024;25(5):717–733. doi:10.1007/s40257-024-00863-2.
- Lee YS, Lee YJ, Lee JM, Han TY, Lee JH, Choi JE. The low-fluence Q-switched Nd:YAG laser treatment for melasma: a systematic review. Medicina (Kaunas). 2022;58(7):936. doi:10.3390/medicina58070936.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 28th Sep 2026
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Expert, consultant led care in dermatology, skin surgery, eyelid surgery, lasers and aesthetics.
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