Taula de Continguts
- Why melasma needs a plan, not a session
- First, confirm that it is melasma
- The combined plan: what each piece does
- Strict sun protection: the non-negotiable part
- Laser and melasma: cautions before switching on the device
- How we work at Santé Madrid
- Maintenance: melasma is managed, not finished
- Frequently asked questions
An aesthetic consultation for melasma in Madrid is there to confirm that your patches really are melasma and to design a combined plan: strict sun protection every day, a depigmenting routine at home, in-clinic procedures only when they are indicated and maintenance planned for the long term. Melasma does not usually resolve with a single session or a single product, and laser, if not properly planned, can make it worse. Here we explain how that plan is built and why maintenance matters as much as the initial treatment.
Key points
- Melasma is a chronic pigmentation disorder that tends to come back; the realistic goal is to lighten it and keep it under control.
- The American Academy of Dermatology states that there is no single ideal treatment and that the most effective approach usually combines sun protection, topical treatment and, sometimes, a procedure.
- Daily sun protection is the foundation of the plan: without it, every other measure loses much of its effect.
- Laser can play a role, but with caution: there is a risk of rebound pigmentation or lighter patches, especially in darker skin types.
- At Santé Madrid the plan is decided by the medical team after assessing your skin. Results vary from skin to skin.
Why melasma needs a plan, not a session
Melasma appears as dark, symmetrical patches on the face; the review we cite below describes three main patterns: centrofacial, on the cheeks (malar) and along the jaw (mandibular). According to the American Academy of Dermatology (AAD), in people with melasma the cells that give skin its colour, the melanocytes, tend to be more active, and the possible triggers it lists include sunlight, pregnancy, birth control pills, some medicines that make skin more sensitive to the sun, tanning beds, thyroid problems and, more controversially, stress. It is also more common in women and in people with relatives who have had it.
A review published in Dermatology and Therapy (Ogbechie-Godec and Elbuluk, 2017) sums it up this way: managing it remains challenging because its cause is not fully understood, it is chronic and it tends to recur. The same review notes that ultraviolet radiation is not the only factor: visible light can also induce pigmentation, especially in darker skin.
The useful question is not which treatment erases the patch, but which combination of measures reduces pigment production, helps remove the pigment that is already there and keeps it from coming back. That is why we talk about a plan: several pieces working together over months.
First, confirm that it is melasma
Not every patch on the face is melasma. Sun spots, the hyperpigmentation left after a spot or irritation and other conditions can look similar, and they are treated differently. The AAD explains that diagnosis is usually made by looking closely at the skin, sometimes with a Wood's lamp or a dermatoscope to estimate how deep the pigment reaches, and that a biopsy is occasionally needed to rule out another condition.
Depth matters. A review of laser and light for melasma published in the International Journal of Women's Dermatology (Trivedi and colleagues, 2017) describes epidermal, dermal, mixed and indeterminate types, and notes that epidermal melasma may respond better to some light-based techniques than mixed or dermal melasma.
In practice, this stage puts the information in order: how long you have had the patches, whether they coincided with a pregnancy or a change of contraceptive, what medication you take, how much sun you get and what you have already tried.
The combined plan: what each piece does
The AAD sums up the current approach in one idea: there is no single ideal treatment, and the most effective approach usually combines sun protection with products applied to the skin and, sometimes, a procedure. The review by Ogbechie-Godec and Elbuluk points the same way: combination therapies generally give better results than a single technique. This table sets out the pieces of the plan and the main caution for each.
| Piece of the plan | What it aims to do | Main caution |
|---|---|---|
| Daily sun protection | Curb the stimulus that darkens the patches and prevent new ones | It has to be consistent all year, not only in summer |
| Depigmenting routine at home | Reduce the production and transfer of pigment | Some actives irritate; irritation can darken the skin |
| Peels and microneedling | Help remove surface pigment and even out tone | Too much inflammation can cause a rebound |
| Laser or light | Speed up pigment removal when the above is not enough | Risk of rebound or lighter patches; it is not a cure |
| Maintenance | Keep what has been achieved and spot relapses early | If it is dropped, melasma tends to come back |
The home routine usually includes cosmetic actives that help even out tone. The review by Ogbechie-Godec and Elbuluk describes, for example, that vitamin C acts as an antioxidant and that niacinamide inhibits the transfer of pigment to surface cells. Which actives, in what order and how often is decided by the team according to your skin, because a routine that irritates can make the patches worse.
Procedures are added on, not substituted. The review by Trivedi and colleagues points out that peels can be useful in a series, but can also cause rebound or hyperpigmentation if they irritate too much.
Strict sun protection: the non-negotiable part
If you could only do one thing, it would be this. The AAD explains that sunlight makes the skin produce more pigment, which can darken existing melasma and cause new patches. Its advice includes a wide-brimmed hat outdoors, seeking shade and applying a broad-spectrum sunscreen with SPF 30 or higher throughout the day. For melasma, it adds that sunscreens with zinc oxide, titanium dioxide or iron oxide are often recommended, and that tinted sunscreens are an alternative if the white cast bothers you.
There is a reason for iron oxide: it protects against part of visible light. The review by Ogbechie-Godec and Elbuluk cites trials in which adding visible-light blockers such as iron oxide to UVA and UVB filters reduced melasma relapses compared with ultraviolet filters alone.
In Madrid summers tend to be sunny, and life outdoors can add up to many hours of sun exposure. That is why protection is part of the daily routine and should not be put away in the cupboard when summer ends. Some habits that help:
- Apply sunscreen every morning, including on cloudy days and even if you work indoors.
- Reapply it during the day if you spend time outside, for example on walks or at terraces.
- Wear a cap or hat and sunglasses during long exposure.
- Avoid tanning beds, which the AAD lists among the triggers.
Laser and melasma: cautions before switching on the device
Laser is the piece that calls for the most caution. The review by Trivedi and colleagues places laser and light as an option for melasma that does not respond to a topical routine or peels, and is clear in its message to patients: these techniques can speed up improvement, but they do not cure melasma, and they carry a risk of post-inflammatory hyperpigmentation or a rebound flare. The same review states that recurrence over time is high, that intense pulsed light is better suited to lighter skin and that vascular lasers do not appear to be effective for melasma.
A systematic review of the low-fluence Q-Switched Nd:YAG laser, published in Medicina (2022), describes it as a generally effective and safe treatment, but reports uncommon and relevant adverse effects: areas of mottled hypopigmentation, which can persist, and rebound hyperpigmentation, more frequent in darker skin types. It also notes relapses after stopping treatment in some studies, and that combining it with other measures generally reduced adverse effects.
At Santé Madrid we work with the Alma Harmony XL Pro laser platform, which includes heads such as Q-Switched, ClearLift and AFT light. According to the manufacturer, ClearLift is a Q-Switch Nd:YAG applicator that delivers nanosecond pulses to treat various pigmentations, and the AFT light applicators offer filters aimed, among other indications, at pigmentation (Alma, Harmony XL Pro). Having the device does not mean your case needs it: if laser makes sense, the medical team chooses the head and the settings, and fits it into the plan with sun protection and a home routine.
How we work at Santé Madrid
Santé Clinics Madrid is at C. de Amador de los Ríos, 1, Chamberí, 28010 Madrid. We are open Monday to Friday from 9:00 to 21:00 and on Saturdays from 10:00 to 15:00; the clinic is closed on Sundays.
With melasma we start with a free aesthetic consultation with a Beauty Coach. We go over the history of your patches, your sun exposure, your routine and what you hope to achieve. Because melasma is linked to hormones and medication, the next step is often a medical consultation, priced at €50, so that the Santé Madrid medical team can assess whether the aesthetic plan is appropriate and which procedures make sense.
With that assessment the plan is built in phases: sun protection and a home routine from day one, with cosmeceuticals available at the clinic when they suit your skin; procedures such as peels or microneedling if they are indicated; and, only when the team considers it appropriate, laser for melasma. If your case needs prescription treatment or does not respond to aesthetic management, we will tell you and recommend a consultation with a dermatologist.
Treatments are performed by the medical team after an assessment, and results vary from skin to skin.
Maintenance: melasma is managed, not finished
According to the AAD, following the plan results usually take between 3 and 12 months to show, and it can take longer if the melasma has been there for years. It also notes that melasma can fade on its own when the trigger was a pregnancy or a medication, and that in other people it lasts for years.
When the patches have lightened, the plan does not end: it changes phase. The review by Trivedi and colleagues describes maintenance as a balance that may include controlling risk factors, topical treatment and occasional procedures, adapted to each person's history, skin type and type of melasma.
In practice, maintenance usually rests on three habits:
- Daily sun protection all year round, with particular attention in spring and summer.
- A simpler home routine than the initial one, reviewed when the season or your skin changes.
- Review visits to spot any darkening early and adjust the plan before it progresses.
If there are hormonal changes, such as a pregnancy or a change of contraceptive, mention it at your next review.
Frequently asked questions
Can melasma be cured?
It is a chronic condition that tends to come back. The realistic goal is to lighten the patches and keep them under control with sun protection, a home routine and reviews. Sometimes it fades on its own if the trigger was a pregnancy or a medication.
Does laser remove melasma in one session?
No. Scientific reviews describe it as a way to speed up improvement, not a cure, and with a risk of rebound or lighter patches. If it is considered, the medical team fits it into a combined plan.
Which sunscreen should I use if I have melasma?
The AAD recommends a broad-spectrum sunscreen with SPF 30 or higher, applied throughout the day. For melasma, products containing zinc oxide, titanium dioxide or iron oxide are usually preferred; tinted sunscreens are a good option.
Can I treat melasma during pregnancy or breastfeeding?
At this stage many procedures are usually postponed. Sun protection is still important, and any product should first be assessed in a medical consultation.
How long does it take to notice an improvement?
According to the AAD, following the plan it usually takes between 3 and 12 months, and it can take longer if the melasma is long-standing. Results vary from skin to skin.
What if my melasma needs prescription treatment?
At Santé Madrid we do not provide prescription dermatology. If your case needs it or does not respond to aesthetic management, we will recommend a consultation with a dermatologist.
How much does the melasma consultation cost?
The aesthetic consultation with a Beauty Coach is free. If the team considers a medical assessment necessary, the medical consultation is priced at €50.
If you have patches that come back every summer or you are not sure whether they are melasma, a consultation at Santé Madrid will help you put a name to them and build a realistic plan.
