Taula de Continguts
- Why melasma is not just another spot
- What keeps melasma active: sun, visible light, heat and hormones
- Why a single aggressive laser is not the answer
- The four pieces of a melasma plan
- Who should wait or see a doctor before starting
- Madrid sun and heat throughout the year
- How we work at Santé Madrid
- Frequently asked questions
Melasma is not resolved with a single laser session: it is a chronic pigmentation that tends to come back, and what works best is a sustained plan with strict photoprotection, topical care, gentle in-clinic options and maintenance. In Madrid, with its summers of intense sun and heat, that plan matters even more. Here we explain why, how a realistic plan is organised and who should wait.
Key points
- Melasma is a chronic, recurrent pigmentation influenced by sun, visible light, heat and hormonal changes.
- It is not the same as a sun spot: it usually appears as symmetrical patches on the face and responds differently to treatment.
- Laser can help in selected cases, but it does not cure melasma, and excessive inflammation or heat can cause a rebound or new spots.
- A sensible plan combines daily sun protection that also covers visible light, topical care recommended after the medical assessment, gentle in-clinic options and a maintenance phase.
- Pregnancy, breastfeeding, tanned skin or a changing spot are reasons to wait or to see a doctor first.
Why melasma is not just another spot
Melasma is an acquired hyperpigmentation that usually appears as brown or greyish, symmetrical patches on the forehead, cheeks, upper lip or chin. It mainly affects women of childbearing age and is often linked to pregnancy, which is why it has also been called "the mask of pregnancy". A review of laser and light therapy in melasma published in the International Journal of Women's Dermatology describes it as a chronic, relapsing pigmentation: treatments can improve the skin temporarily, but the condition often returns.
That is the difference from sun spots, or lentigines. A lentigo is a well-defined spot that appears after years of sun, often on exposed areas such as the face or the back of the hands. Melasma, on the other hand, forms larger, more diffuse patches and depends on melanocytes that remain active and react to everyday triggers such as sun, light or hormonal changes. That is why it is not treated as a spot to be erased, but as a tendency of the skin that needs to be kept under control.
The Fundación Piel Sana of the Spanish Academy of Dermatology and Venereology sums it up in its article on laser for melasma and other pigmentation: melasma is one of the most common pigmentary conditions and one of the most difficult to treat.
What keeps melasma active: sun, visible light, heat and hormones
There is no single cause. A review of the exposome in melasma published in Clinical, Cosmetic and Investigational Dermatology explains that its onset and persistence involve internal factors, such as hormone levels, oxidative stress or psychological stress, and external factors, such as ultraviolet radiation, visible light, air pollution, some medicines and skincare habits.
According to that review, oestrogen and progesterone are directly related to the onset and worsening of melasma, and sustained ultraviolet radiation is associated with its relapse. Visible light also matters: both skin with melasma and the skin around it can produce more melanin when exposed to it, especially blue and violet light, and that pigmentation tends to last longer than the one caused by UVA and UVB rays. The authors also cite studies that associate prolonged heat exposure with more severe melasma.
This has a practical consequence. If melasma is fed by the sun, light and heat you receive every day, no one-off treatment can make up for unprotected daily exposure. The same review notes that traditional therapies act on pigment that has already formed, with high relapse rates, and proposes management that includes full-spectrum photoprotection, repair of the skin barrier and lifestyle adjustments.
Why a single aggressive laser is not the answer
It is understandable to want a quick solution, but the melanocyte in melasma is especially reactive: inflammation and heat can stimulate it. The review of laser and light therapy in melasma stresses a message worth hearing before any session: laser and light can speed up the removal of pigment, but they do not cure melasma, and they carry a risk of post-inflammatory hyperpigmentation or a rebound of melasma.
That review places laser and light as an option for cases that have not responded to topical treatment or peels, always combined with that topical treatment. It also warns that over time there is a high recurrence rate, that some techniques increase the risk of darker or lighter spots, and that ablative fractional lasers should be used with caution because that risk is very high. Along the same lines, the Fundación Piel Sana article notes that laser is one more tool, to be indicated in well-selected cases, that the usual starting point is topical depigmenting agents and that relapses are frequent in a high percentage of patients.
That is why, when we talk about laser for melasma at Santé, we mean one piece within a plan, with cautious settings, and never an intense session that fixes everything. We explain this in more detail in our article on melasma and laser: necessary precautions.
The four pieces of a melasma plan
The laser and light review describes the goal of treatment as a balance: reduce what stimulates pigment production and support its removal, and, once the desired lightening is achieved, find a maintenance routine that keeps that balance. The table gives an approximate summary of how this translates into a plan.
| Piece of the plan | Goal | What it usually includes |
|---|---|---|
| Strict photoprotection | Reduce the daily stimulus from sun and visible light | Tinted broad-spectrum sunscreen, reapplication, a hat and shade |
| Topical care | Slow pigment production and look after the skin barrier | Depigmenting and soothing products recommended by the doctor after the assessment |
| Gentle in-clinic options | Help remove pigment while trying not to cause inflammation | Superficial peels or laser with cautious settings, only if the doctor recommends it |
| Maintenance | Sustain the improvement and reduce relapses | Check-ups, adjustments to home care and occasional sessions if needed |
There is an important nuance about photoprotection. A study published in the Journal of Cosmetic Dermatology, funded by a cosmetics manufacturer and carried out in summer in southern France with women with melasma, observed that a high UVA and UVB sunscreen helped prevent darkening, and that adding pigments that filter visible light, such as the iron oxides in tinted sunscreens, also improved the evenness of skin tone. Results vary from skin to skin, and the order and pace of each piece are decided by the doctor in each case.
Who should wait or see a doctor before starting
A melasma plan starts with knowing whether the timing is right. During pregnancy and breastfeeding, the priority is to protect the skin from sun and heat: aesthetic procedures on pigmentation are usually postponed, and any product you use should be checked with a doctor first. If melasma appeared or worsened when you started a hormonal treatment, discuss it with the doctor who prescribed it; do not stop it on your own. The exposome review also notes that some medicines can induce or worsen pigmentation, so it is worth bringing a list of what you take to the consultation.
Madrid sun and heat throughout the year
Madrid has a dry continental climate, with sunny, hot summers and cold winters. For skin with melasma, this often translates into a familiar cycle: pigmentation improves in the colder months and darkens again with the sun and heat of spring and summer. This is not a failure of treatment but the nature of melasma, which is why the plan has to stay with you all year round.
Protection is not limited to the beach: walks around Chamberí or Salamanca, café terraces or the car also add up to exposure. A tinted sunscreen, reapplying at midday, a wide-brimmed hat and seeking shade during the middle of the day are more useful habits than any single session. Heat also matters: the exposome review cites studies that associate prolonged heat exposure with more severe melasma, so it is wise not to overdo saunas, very hot baths or intense exercise in the sun.
That is why in-clinic sessions are usually concentrated in autumn and winter, with summer reserved for protection and maintenance. If you want to understand that cycle better, we cover it in our article on why melasma returns every summer. Winter heating and urban pollution can dry out or irritate the skin, so a well-cared-for skin barrier is part of the plan.
How we work at Santé Madrid
Our clinic is at C. de Amador de los Ríos, 1, Chamberí, 28010 Madrid. This is what the process usually looks like when you come in for melasma:
- First consultation. You can start with a free aesthetic assessment with a Beauty Coach or with a medical consultation for €50. We go over when the pigmentation appeared, pregnancies, hormonal treatments, medication, sun and heat exposure, and what you have tried before.
- Skin assessment. The Santé Madrid medical team confirms whether it is melasma, whether it coexists with sun spots or other lesions, and whether anything needs to be looked into first.
- Written plan. The doctor proposes photoprotection, topical care at home and, if indicated, gentle in-clinic options, such as peels or laser for melasma with cautious settings on the Harmony XL Pro, with a schedule adapted to the time of year.
- Follow-up. We review how your skin responds and adjust the plan, without raising the intensity out of haste.
- Maintenance. Once the pigmentation is better controlled, we move to maintenance care with regular check-ups.
Treatment is carried out by the medical team after the assessment. Results vary from skin to skin and melasma can come back, so our goal is a realistic, safe plan for you, not a promise of results.
Frequently asked questions
Can melasma be cured?
Melasma is a chronic, recurrent condition. It can improve and stay under control with a plan, but it tends to come back if the triggers change, especially sun, light and hormones.
Why don't you just do one strong laser session?
Because inflammation and heat can stimulate the melanocytes in melasma and cause a rebound or new spots. Laser, if indicated, is used with cautious settings and always within a plan.
How is melasma different from a sun spot?
A sun spot is a well-defined lesion caused by years of sun. Melasma usually forms symmetrical patches on the face, is also linked to hormones, visible light and heat, and tends to reappear.
What sunscreen do I need if I have melasma?
A broad-spectrum one with high UVA and UVB protection. Tinted sunscreens, which contain pigments such as iron oxides, also help against visible light. It needs to be reapplied throughout the day.
Can I treat melasma if I am pregnant?
During pregnancy and breastfeeding, sun protection comes first and aesthetic procedures on pigmentation are postponed. Any product you use should be checked with a doctor first.
When is a good time to start?
You can start photoprotection and home care at any time. In-clinic sessions are usually concentrated in autumn and winter, with untanned skin, but the doctor decides in each case.
How long does the plan last?
There is no fixed duration. There is a phase to lighten the pigmentation and a maintenance phase that usually continues over time. The doctor adjusts the plan at each check-up according to how your skin responds.
Melasma calls for consistency more than intensity: protecting the skin every day, caring for it at home, using gentle options when they are indicated and maintaining what has been achieved. If you notice symmetrical patches on your face that get worse with sun or heat, the first step is an assessment with the Santé Madrid medical team.
