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Pigmentary Physician Reviewed

Melasma — controlled by dermatologists, not concealed

A stubborn pigmentary condition that disproportionately affects Indian skin — managed with precision depigmenting protocols at DermaVue's 7 clinics across Kerala & Tamil Nadu.

Chloasma Mask of Pregnancy Facial Hyperpigmentation Sun Spots Pigmentation Patches
Affects Face (cheeks, forehead, upper lip, chin)
Age Group 20 – 50 years
Contagious No
Treatment 4 – 8 sessions
Consultation ₹300
At a Glance
0–30%
of Indian women of reproductive age affected by melasma
0%
of melasma cases occur in women — hormones are a primary driver
0%+
DermaVue patient satisfaction across 7,400+ reviews
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7 clinics · Kerala & Tamil Nadu · ₹300 consultation

What Is It

Understanding Melasma

Reviewed by Dr. Minu Liz Mathew, MBBS MD DVL — February 2026

Melasma causes brown or greyish-brown patches on the face — most commonly on the cheeks, forehead, bridge of the nose, and upper lip. It is driven by a combination of UV exposure, hormonal changes, and genetic predisposition, making it particularly common among Indian women with Fitzpatrick IV–VI skin types. Kerala's year-round tropical sun exposure is a significant aggravating factor. DermaVue dermatologists use a layered approach combining prescription depigmenting agents, chemical peels, and advanced laser protocols — tailored to melasma type and skin phototype for sustained pigment control.

Melasma is a chronic acquired hypermelanosis characterised by symmetric, irregularly bordered, light-to-dark brown macules and patches on sun-exposed facial skin. Pathogenesis involves UV-induced upregulation of melanocyte-stimulating hormone (α-MSH), oestrogen and progesterone receptor–mediated melanogenesis, and vascular endothelial growth factor (VEGF)-driven dermal angiogenesis contributing to treatment resistance.[1] Histologically classified as epidermal, dermal, or mixed type — a distinction critical for treatment selection. Wood's lamp examination differentiates epidermal (enhanced under UV) from dermal (no enhancement) melanin deposition. Indian Fitzpatrick IV–VI skin carries elevated recurrence risk due to constitutively active melanocytes and year-round UV exposure in tropical latitudes.[2]

M
Dr. Minu Liz Mathew, MBBS MD DVL
Consultant Dermatologist · RealSelf Recognised · DermaVue Kochi
Last reviewed: February 2026
Signs & Symptoms

What does Melasma look like?

Symptoms range widely in severity. Identifying which type you have determines the right treatment.

Bilateral Cheek Patches

Symmetric brown or greyish-brown patches on both cheeks — the most common malar pattern of melasma. Borders are irregular but well-demarcated.
Moderate

Forehead Darkening

Broad, diffuse hyperpigmented band across the forehead — often continuous with cheek patches in the centrofacial pattern.
Moderate

Upper Lip Pigmentation

Darkening of the skin above the upper lip — frequently mistaken for a shadow. Often the most cosmetically distressing area for patients.
Moderate

Chin & Jawline Patches

Mandibular pattern melasma — less common but can coexist with malar and centrofacial involvement. Often linked to hormonal triggers.
Moderate

Worsening with Sun Exposure

Patches darken visibly after even brief sun exposure. UV radiation triggers melanocyte activation within minutes. Particularly problematic in Kerala's tropical climate.
Mod. Severe

Post-Treatment Recurrence

Pigmentation returns after seemingly successful treatment — a hallmark of melasma. Maintenance therapy and strict sun protection are essential to sustain results.
Mod. Severe

Textural Irregularity

Affected skin may feel slightly rough or show subtle textural changes compared to surrounding normal skin. No scaling or itching in typical melasma.
Mild

Emotional & Social Impact

Visible facial pigmentation significantly affects self-esteem and social confidence. Studies show melasma impairs quality of life comparably to other chronic dermatoses in Fitzpatrick IV–VI populations.
Mod. Severe
Root Causes

What actually causes Melasma?

Multiple factors act together — understanding them helps prevent recurrence after treatment.

☀

Ultraviolet Radiation

UV exposure is the single most important trigger for melasma. UVA and visible light activate melanocytes and upregulate tyrosinase activity. Kerala's tropical latitude (8–12°N) delivers intense UV year-round, making daily broad-spectrum SPF 50+ sunscreen non-negotiable.
⚡

Hormonal Influences

Oestrogen and progesterone stimulate melanogenesis directly. Melasma commonly appears or worsens during pregnancy, oral contraceptive use, and hormone replacement therapy. PCOD-linked hormonal imbalance is a frequent trigger in Indian women.
🧬

Genetic Predisposition

Family history is present in over 40% of melasma patients. Genetic variants affecting melanocortin-1 receptor (MC1R) and other pigmentation genes increase susceptibility — especially prevalent in South Asian populations.
🌡

Heat & Humidity (Kerala Climate)

Thermal exposure and high humidity independently activate melanocytes. Kerala's sustained heat and humidity act as a constant aggravating factor, even without direct sun exposure — explaining why indoor workers also develop melasma.
🧴

Irritant Skincare & Cosmetics

Harsh products, chemical irritants, and comedogenic cosmetics cause subclinical inflammation that stimulates melanocyte activity. Self-prescribed steroid creams — extremely common in India — worsen melasma and cause steroid-dependent skin.
💊

Medications

Certain drugs including anti-epileptics, phototoxic antibiotics, and some anti-hypertensives can trigger or worsen melasma. A full medication review is part of DermaVue's diagnostic protocol.
↻

Visible Light Exposure

Visible light (400–700 nm), including blue light from screens, triggers melanogenesis in darker skin types — a recently recognised aggravator. Standard sunscreens alone may not block visible light; tinted or iron oxide–containing formulations are recommended.
Who gets melasma in India?
  • 20–30% of Indian women of reproductive age are affected — one of the highest prevalences globally
  • Women account for 90% of cases; men represent 10% but are often underdiagnosed and undertreated
  • Peak onset between 20–40 years — coinciding with hormonal milestones (pregnancy, OCP use, PCOD)
  • Kerala & South India carry elevated risk due to tropical UV intensity, sustained humidity, and high prevalence of Fitzpatrick IV–V skin phototypes
  • Fitzpatrick IV–VI skin types have constitutively active melanocytes, making melasma more severe and more resistant to treatment than in lighter skin
Diagnosis Process

What happens at your DermaVue consultation?

A structured clinical assessment — not a quick glance and a prescription pad. Here's exactly what to expect.

01

Clinical Examination & Pattern Mapping

Dermatologist identifies melasma distribution pattern — malar, centrofacial, or mandibular. Lesion borders, colour depth, and symmetry are assessed. Standardised baseline photographs taken under consistent lighting.
02

Wood's Lamp Examination

UV light examination differentiates epidermal melasma (pigment enhances under Wood's lamp) from dermal melasma (no enhancement). Mixed-type melasma shows partial enhancement. This classification directly guides treatment selection and prognosis discussion.
03

Dermoscopy & MASI Scoring

Dermoscopic assessment evaluates pigment depth, vascularity, and network patterns. Melasma Area and Severity Index (MASI) score calculated for objective severity grading and treatment response tracking over time.
04

Hormonal & Trigger Assessment

Review of hormonal status (pregnancy, OCP, PCOD), medication history, sun exposure habits, and skincare routine. Thyroid function and hormonal panel ordered when clinical pattern suggests endocrine contribution.
05

Personalised Treatment Protocol

Written treatment plan combining topical depigmenting agents, in-clinic procedures, sun protection strategy, and maintenance regimen — matched to melasma type (epidermal vs dermal vs mixed), Fitzpatrick phototype, and patient lifestyle.
Available at DermaVue

Melasma treatments we offer

All procedures by board-certified MD DVL dermatologists. US-FDA approved equipment. No technician-only protocols — ever.

Topical Depigmenting Agents

Dermatologist-prescribed combination of hydroquinone, tretinoin, azelaic acid, or tranexamic acid — selected by melasma type and skin sensitivity. Modified Kligman's formula remains a first-line approach with careful monitoring.
Epidermal melasma — first-line therapy

Chemical Peels

Superficial peels using glycolic acid, lactic acid, or modified Jessner's solution reduce epidermal melanin load and enhance topical agent penetration. Series of 4–6 sessions spaced 2–4 weeks apart.
Epidermal & mixed melasma

Tranexamic Acid Therapy

Oral and/or intradermal tranexamic acid inhibits plasminogen activation in keratinocytes, reducing UV-induced melanogenesis. Emerging evidence supports significant MASI score reduction with a favourable safety profile.
Recalcitrant & mixed-type melasma

Q-Switched Nd:YAG Laser

Low-fluence 1064 nm laser toning fragments dermal melanin without thermal damage to surrounding tissue. Requires 6–10 sessions at 1–2 week intervals. Must be combined with topical maintenance to prevent rebound.
Dermal & mixed melasma

Microneedling + Depigmenting Serums

Controlled micro-injury enhances transdermal delivery of vitamin C, tranexamic acid, and other depigmenting actives into the target skin layer. Safer for darker skin types than aggressive laser approaches.
Treatment-resistant melasma in Fitzpatrick IV–VI

HydraFacial with Britenol

Deep cleansing, exfoliation, and infusion of alpha-arbutin and vitamin C brightening serums in a single session. Immediate glow with no downtime. Complements ongoing depigmenting treatment.
Maintenance & mild epidermal pigmentation

Glutathione + Vitamin C IV

Systemic antioxidant therapy reduces oxidative stress driving melanogenesis and inhibits tyrosinase activity. Adjunctive to topical and procedural treatment — not a standalone therapy.
Adjunctive pigment reduction & skin brightening
Find Melasma Treatment Near You
Thiruvananthapuram Kochi Thrissur Kollam Thiruvalla Kottayam Coimbatore
Treatment Journey

Your Melasma treatment timeline

Results are gradual, progressive, and lasting with the right protocol.

Week 1
Consultation, Wood's lamp examination, MASI scoring & baseline photos. Melasma type classified. Topical depigmenting regimen initiated with strict sunscreen protocol.
Sun protection education — SPF 50+ broad-spectrum with reapplication every 2 hours, physical barriers discussed.
Month 1–2
Topical agents working. First chemical peel or HydraFacial session completed. Early lightening visible in epidermal-type cases. 15–25% MASI score improvement expected.
Second peel session. Skin tolerance assessed. Formulation adjusted if irritation occurs.
Month 3–4
Cumulative effect of peels and topicals. 40–60% improvement in most epidermal and mixed cases. Laser toning initiated if dermal component is significant.
Tranexamic acid (oral or intradermal) added for recalcitrant cases. MASI rescored.
Month 5–6
Significant pigment reduction achieved. Maintenance protocol established — lower-strength topical, monthly peel or HydraFacial, daily photoprotection.
Patients transitioned from active treatment to maintenance phase. Relapse prevention emphasised.
Month 6+
Ongoing maintenance phase. Quarterly dermatologist review. Sustained improvement depends on daily sunscreen compliance and trigger avoidance.
Melasma is managed, not cured. Maintenance compliance determines long-term pigment control.
Expert Videos

Watch: Melasma treatment at DermaVue

Our dermatologists explain diagnosis, treatment options, and what to expect.

Effective Melasma Treatment — Erase Hyperpigmentation

Laser Toning for Melasma and Pigmentation

FAQ

Frequently asked questions about Melasma

No, melasma is not contagious. It cannot be transmitted by touch, sharing towels, or any form of contact. Melasma is caused by a combination of UV exposure, hormonal factors, and genetic predisposition — it is purely an internal pigmentary disorder with no infectious component.

Melasma is a chronic condition that can be effectively controlled but not permanently cured in most cases. With consistent treatment — including topical depigmenting agents, chemical peels, and strict sun protection — significant and sustained pigment reduction is achievable. However, recurrence is common without maintenance therapy and daily broad-spectrum sunscreen use.

Kerala's tropical latitude delivers intense UV radiation year-round — the primary trigger for melasma. High ambient humidity and heat independently stimulate melanocyte activity even without direct sun exposure. Outdoor work, commuting without sun protection, and inconsistent sunscreen use significantly worsen pigmentation. DermaVue protocols account for these local environmental factors.

DermaVue consultation fee is ₹300 at most branches. Chemical peel sessions for melasma range ₹2,000–4,000 per session. Laser toning sessions start at ₹3,500. Topical prescription costs depend on formulation and duration. A complete cost estimate is provided at your first consultation — no hidden charges or pressure to buy packages.

Yes. Melasma presents as larger, symmetric patches with irregular borders — distinct from post-inflammatory hyperpigmentation (PIH) marks left after acne or injury. PIH fades predictably over months, while melasma tends to persist and worsen with sun exposure. Melasma also involves deeper dermal melanin deposition in many cases, making it more treatment-resistant than superficial dark spots.

Yes, approximately 10% of melasma cases occur in men. Male melasma is often underdiagnosed because it is perceived as a predominantly female condition. UV exposure, genetic predisposition, and certain medications are the primary triggers in men. Treatment protocols are similar — DermaVue dermatologists treat melasma in both men and women with the same evidence-based approach.

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