Quick answer: Melasma in Indian women is caused by a combination of UV exposure, hormonal changes, and heat, all of which overstimulate melanocytes (pigment-producing cells) in the skin. Indian skin is more prone to melasma because it has more reactive melanocytes than lighter skin types. Treatment requires a combination of strict sun protection, prescription topical depigmenting agents, and clinic procedures. It cannot be permanently cured, but it can be significantly lightened and kept under control.
Melasma presents in consultation as brown or greyish-brown patches on the cheeks, upper lip, forehead, and nose. Patients often describe it as a shadow on the face that appeared during pregnancy and never fully went away, or one that appeared after they started an oral contraceptive and has been getting darker every summer.
The frustration most patients express is not just about the appearance. It is about the cycle: the patches fade slightly in winter or after a course of treatment, then come back darker in summer. Understanding why this happens is what changes how patients approach treatment.
Written by Dr. Sarath Chandran, MD DVL, IADVL-registered dermatologist and Managing Director, DermaVue Clinics. Peer reviewed by Dr. Minu Liz Mathew, MD DVL, Clinical Director, Kochi.
Table of Contents
- What Melasma Is and Why Indian Skin Is Particularly Prone to It
- What Causes Melasma: The Three Primary Triggers
- Why Melasma Keeps Coming Back
- Types of Melasma and Why the Type Affects Treatment
- What Does Not Work and Why
- What Actually Works: The Combination Approach
- How Long Treatment Takes
- Melasma Treatment at DermaVue
- Frequently Asked Questions
What Melasma Is and Why Indian Skin Is Particularly Prone to It
Melasma is a form of hyperpigmentation caused by the overproduction of melanin (the pigment that gives skin its colour) in specific areas of the face. The melanocytes (melanin-producing cells) in affected areas become overactive and produce more pigment than the surrounding skin, resulting in the characteristic brown or grey-brown patches.
Indian skin (Fitzpatrick type IV to VI) is significantly more prone to melasma than lighter skin types. Studies published in the Indian Journal of Dermatology, Venereology and Leprology estimate that melasma affects between 25 and 40 percent of Indian women at some point in their lives, making it one of the most common dermatological concerns in this population. The reason is biological: Indian skin has more numerous and more reactive melanocytes. Any stimulus that activates these cells, including UV radiation, hormones, and heat, produces a stronger and more sustained pigmentation response than it would in lighter skin.
This is not a disease in the traditional sense. It is a pattern of melanocyte behaviour that is influenced by multiple external and internal factors simultaneously. This is also why treating it with a single product or approach rarely produces lasting results.
What Causes Melasma: The Three Primary Triggers
1. UV exposure
UV radiation is the most consistent and most powerful trigger for melasma. UV-A and UV-B rays both stimulate melanocytes directly, triggering melanin production. UV-A rays, which penetrate glass and are present even on cloudy days, are particularly relevant for melasma because they activate the deeper melanocytes responsible for the dermal (deep) type of melasma.
In Kerala and Tamil Nadu, where UV index regularly exceeds 10 (very high to extreme) for most of the year, unprotected sun exposure is the single biggest factor driving melasma persistence and recurrence. Patients who use SPF 30 but reapply infrequently, or who do not use a physical block (zinc oxide or titanium dioxide), are effectively not protecting themselves against the UV-A radiation that most directly drives melasma.
2. Hormonal changes
Oestrogen and progesterone directly stimulate melanocyte activity. This is why melasma is so common during pregnancy (known as chloasma or the mask of pregnancy), during oral contraceptive use, and during hormonal fluctuations related to PMOS and perimenopause.
In Indian women, PMOS is a particularly relevant hormonal trigger. The androgen excess associated with PMOS creates a hormonal environment that sensitises melanocytes. Women with PMOS who use combined oral contraceptives to manage symptoms may paradoxically worsen melasma through the oestrogen component. Read more about PMOS at DermaVue.
Hormonal triggers do not cause melasma independently. They sensitise melanocytes to other triggers, particularly UV radiation. This is why melasma triggered by pregnancy often fades after delivery but does not disappear entirely, and why it reappears more severely with subsequent sun exposure.
3. Heat
Heat is an underappreciated but well-documented melasma trigger. Infrared radiation from the sun, cooking over open flames, and even hot showers can activate melanocytes independently of UV exposure. This explains why some patients with excellent sun protection habits still experience melasma worsening: they are exposed to significant heat sources during the day.
For patients in Coimbatore, where summer temperatures regularly exceed 38 to 40 degrees Celsius, heat as an independent trigger is particularly relevant. Tinted physical sunscreens with iron oxide pigments provide some protection against visible light and infrared radiation in addition to UV.
Why Melasma Keeps Coming Back
This is the question that frustrates patients the most. The patches fade with treatment, then return. The reason is not treatment failure. It is the biology of melasma.
Melasma is a chronic condition, not an acute one. The melanocytes in affected areas have been conditioned to be hyperreactive. Even after the excess pigment is removed through treatment, those melanocytes retain their sensitivity. Any subsequent UV exposure, hormonal change, or heat stimulus triggers renewed pigment production.
Treatment addresses the excess pigment that has already been produced. It does not change the underlying melanocyte sensitivity. This is why maintenance treatment (ongoing sun protection and periodic clinic procedures) is part of a realistic long-term management plan, not a sign that the initial treatment failed.
Melasma recurrence is also worsened by post-inflammatory hyperpigmentation from other skin concerns. Acne spots, irritation from harsh skincare products, and thread vein treatments on the face can all produce PIH in melasma-prone skin that compounds the existing pigmentation. See the related discussion in our post on adult acne and post-inflammatory hyperpigmentation.
Types of Melasma and Why the Type Affects Treatment
Melasma exists at different depths within the skin, and the depth determines how it responds to treatment.
| Type | Depth | Appearance | Treatment response |
|---|---|---|---|
| Epidermal | Superficial (upper skin layers) | Brown, well-defined borders | Best response to topical agents and superficial peels |
| Dermal | Deep (dermis) | Grey-brown, less defined borders | Slower response; requires laser toning in addition to topicals |
| Mixed | Both epidermal and dermal | Mixed brown and grey-brown | Requires a combined approach; most common type in Indian patients |
A Wood’s lamp examination at the dermatology clinic identifies the depth. Epidermal melasma fluoresces under Wood’s lamp light; dermal melasma does not. Most Indian patients present with mixed-type melasma, which is why treatment plans typically combine topical agents (for the epidermal component) with clinic procedures (for the dermal component).
What Does Not Work and Why
OTC fairness creams: Most fairness creams available in Indian pharmacies and supermarkets contain subtherapeutic concentrations of active ingredients and in some cases contain unlisted steroids or mercury, both of which cause serious harm with prolonged use. Steroids in OTC creams cause initial lightening followed by severe rebound pigmentation and skin thinning.
Single-ingredient brightening serums without sun protection: Vitamin C, niacinamide, and kojic acid all have evidence for mild brightening effects on early pigmentation. Used without consistent SPF 50 or above, they produce no measurable improvement in melasma because UV exposure every morning undoes whatever brightening occurred overnight.
Aggressive chemical peels without preparation: High-concentration peels applied without adequate skin preparation and photoprotection cause post-inflammatory hyperpigmentation on Indian skin, which worsens melasma. Peels for melasma must be preceded by 4 to 6 weeks of topical preparation and followed by strict sun protection.
Home laser and IPL devices: Consumer-grade devices do not produce the clinical-grade wavelengths and energy levels needed for melasma treatment. At-home IPL can trigger reactive pigmentation on Indian skin.
What Actually Works: The Combination Approach
Effective melasma management in Indian patients requires three simultaneous tracks. Addressing any one in isolation produces incomplete and temporary results.
Track 1: Photoprotection (non-negotiable foundation)
- SPF 50 or above, broad-spectrum (covering both UV-A and UV-B), applied every morning as the last step in the skincare routine before going out
- Reapplication every 2 hours during outdoor exposure
- Tinted physical sunscreen with iron oxide for protection against visible light and heat radiation, particularly relevant for darker skin tones
- Physical sun protection (wide-brimmed hats, UV-protective clothing) during prolonged outdoor exposure
No treatment produces lasting results without this foundation. Patients who complete a clinical treatment course but return to unprotected sun exposure will see melasma return within weeks.
Track 2: Prescription topical agents
Hydroquinone 2 to 4 percent: The most extensively studied depigmenting agent. US-FDA approved for melasma treatment. Inhibits the enzyme tyrosinase, which is required for melanin production. Used for 8 to 12 weeks in cycles (not continuously, to prevent ochronosis). Most effective when combined with a retinoid and a mild topical steroid (the Kligman formula) but requires dermatologist supervision.
Azelaic acid 15 to 20 percent: Inhibits melanin production and has anti-inflammatory properties. Well-suited for melasma in patients who cannot use hydroquinone (during pregnancy, for example). Safe for long-term use.
Tranexamic acid (topical and oral): A newer option with strong evidence for melasma in Indian skin. Oral tranexamic acid at low doses (250mg twice daily) produces significant reduction in melasma severity. Topical formulations are less potent but useful for maintenance.
Retinoids: Accelerate cell turnover, which speeds the elimination of pigmented cells from the surface. Not directly depigmenting but enhance the effect of other agents. Must be used with strict sun protection.
Niacinamide: Reduces the transfer of melanin from melanocytes to surrounding skin cells. Less potent than the above but well-tolerated and useful as a maintenance agent.
Track 3: Clinic procedures
Chemical peels (glycolic, lactic, or mandelic acid): Superficial to medium-depth peels remove the outer layers of pigmented skin and accelerate cell turnover. Mandelic acid peels are particularly well-suited for Indian skin because they carry a lower risk of post-inflammatory hyperpigmentation than glycolic acid. Our guide to chemical exfoliants for Indian skin explains how these acids work at the cellular level.
Laser toning (Q-switched Nd:YAG): Low-fluence Q-switched Nd:YAG laser targets dermal melanin deposits that topicals and peels cannot reach. Multiple sessions (typically 6 to 10) produce gradual, even lightening without the risk of post-inflammatory hyperpigmentation associated with higher-energy laser settings. Requires ongoing sun protection and maintenance.
Tranexamic acid mesotherapy: Intradermal delivery of tranexamic acid directly into the dermis produces faster localised results than oral or topical tranexamic acid for the dermal component of melasma.
How Long Treatment Takes
| Timeframe | What to expect |
|---|---|
| Weeks 1 to 4 | Skin adjusting to topical agents. Some initial irritation or mild peeling from retinoids is normal. No visible lightening yet. |
| Weeks 4 to 8 | Early lightening of the epidermal component. Borders of patches may begin to soften. SPF adherence is critical during this period. |
| Weeks 8 to 12 | Significant improvement in most patients with epidermal melasma. Mixed-type melasma shows partial improvement. |
| Months 3 to 6 | Clinic procedures (peels and laser toning) are added after topical preparation. Dermal component begins to lighten. |
| Months 6 to 12 | Maximum improvement achieved in most patients. Maintenance therapy begins (periodic clinic procedures and ongoing sun protection). |
| Long-term | Periodic maintenance sessions (every 3 to 6 months) and strict photoprotection prevent recurrence. |
Patients who expect complete clearance in 4 weeks are not setting realistic expectations. Melasma, particularly the mixed-type common in Indian patients, is a 6 to 12 month treatment commitment followed by long-term maintenance.
Melasma Treatment at DermaVue
DermaVue offers melasma assessment and treatment across all seven clinics in Kerala and Tamil Nadu. Every melasma consultation begins with a Wood’s lamp examination to identify the depth of pigmentation and a review of current sun protection habits, hormonal history, and skincare routine. Treatment plans are individualised and combine prescription topicals with clinic procedures based on the melasma type and severity.
All consultations are conducted by IADVL-registered MD DVL dermatologists.
| Branch | Melasma Treatment Page | Phone |
|---|---|---|
| Thiruvananthapuram | Melasma Treatment TVM | +91 83308 60007 |
| Kollam | Melasma Treatment Kollam | +91 80868 60465 |
| Thiruvalla | Melasma Treatment Thiruvalla | +91 80860 00608 |
| Kottayam | Melasma Treatment Kottayam | +91 81298 83331 |
| Kochi (Aluva) | Melasma Treatment Kochi | +91 90720 07733 |
| Thrissur | Melasma Treatment Thrissur | +91 73567 42225 |
| Coimbatore | Melasma Treatment Coimbatore | +91 80868 60018 |
Book a melasma consultation at your nearest branch. Visit dermavue.com/locations, call the branch directly, or WhatsApp our Thiruvananthapuram team for the clinic nearest to you.
Related Reading
- Melasma Treatment at DermaVue
- Chemical Exfoliants for Indian Skin: AHA, BHA and PHA Explained
- Adult Acne and Post-Inflammatory Hyperpigmentation
- PMOS and Metabolic Health at DermaVue
Frequently Asked Questions
What causes melasma in Indian women? Melasma in Indian women is caused by the overactivation of melanocytes (pigment-producing cells) triggered primarily by UV exposure, hormonal changes (pregnancy, oral contraceptives, PMOS, perimenopause), and heat. Indian skin has more numerous and more reactive melanocytes than lighter skin types, which is why melasma is significantly more common in this population, affecting an estimated 25 to 40 percent of Indian women.
Why does melasma keep coming back after treatment? Melasma recurs because treatment removes the excess pigment already produced but does not change the underlying melanocyte sensitivity. The melanocytes in affected areas remain hyperreactive to their triggers (UV, hormones, heat). Any subsequent exposure to these triggers restimulates pigment production. This is why strict photoprotection must continue even after successful treatment, and why periodic maintenance clinic sessions are part of realistic long-term management.
Is melasma permanent? Melasma is a chronic condition, not a permanent fixed pigmentation. It can be significantly lightened and kept under control with the right combination of sun protection, prescription topicals, and clinic procedures. It cannot be permanently cured in the sense of removing the underlying melanocyte sensitivity, but patients who maintain treatment and photoprotection can keep melasma at a level that is not cosmetically significant.
What is the best treatment for melasma on Indian skin? No single treatment is sufficient for melasma on Indian skin. The most effective approach combines daily SPF 50 or above (reapplied every 2 hours outdoors), prescription topical agents (hydroquinone, azelaic acid, tranexamic acid, or retinoids depending on the clinical situation), and clinic procedures (chemical peels and laser toning for the dermal component). The combination and sequence of these is determined after a clinical assessment of the melasma type and depth.
Can melasma be caused by PMOS? Yes. PMOS (polyendocrine metabolic ovarian syndrome, previously called PCOS) creates hormonal conditions that sensitise melanocytes to pigmentation triggers. Elevated androgens and the associated hormonal imbalance can worsen melasma, particularly in women who are also taking combined oral contraceptives for PMOS management. If you have melasma alongside signs of PMOS such as irregular periods, excess facial hair, or acne on the chin and jawline, a dermatologist will consider the hormonal component alongside the topical treatment plan.
How long does melasma treatment take to work? Most patients see early lightening of the epidermal (superficial) component within 4 to 8 weeks of starting prescription topical agents with consistent sun protection. Significant improvement typically becomes visible by 8 to 12 weeks. The dermal (deep) component of melasma, which is more common in Indian patients, requires clinic procedures in addition to topicals and may take 6 to 12 months to show substantial improvement.
Is SPF 30 enough for melasma? For melasma management, SPF 50 or above is recommended over SPF 30. More importantly, the sunscreen must be broad-spectrum (covering both UV-A and UV-B), must be applied every morning as the last skincare step, and must be reapplied every 2 hours during outdoor exposure. A tinted physical sunscreen containing iron oxide provides additional protection against visible light and heat radiation, both of which can trigger melasma independently of UV.
Can chemical peels make melasma worse? Chemical peels can worsen melasma if used incorrectly on Indian skin. High-concentration peels applied without adequate skin preparation or on unprotected skin can cause post-inflammatory hyperpigmentation that compounds the melasma. At DermaVue, melasma peels use appropriate acids (mandelic or lactic acid rather than glycolic for most Indian patients), are preceded by 4 to 6 weeks of topical preparation, and are followed by strict sun protection protocols. When done correctly, peels are effective at addressing the epidermal component of melasma.
Authored by Dr. Sarath Chandran, MD DVL, IADVL-registered dermatologist and Managing Director, DermaVue Clinics. Peer reviewed by Dr. Minu Liz Mathew, MD DVL, Clinical Director, Kochi. Published August 2026. This article is for general information and does not substitute a clinical consultation. Individual treatment plans vary based on melasma type, depth, hormonal status, and skin history.
