The Melasma Guide: Why Your Current Treatment Might Be Making It Worse

If you are reading this, you have probably already spent months, maybe years, trying to treat melasma. You have purchased the expensive serums, endured chemical peels, and perhaps even tried laser, only to watch the pigmentation return, sometimes darker than it was before the treatment. That experience is not unusual. In fact, it is one of the most common stories we hear at our Dural clinic.

The problem is rarely a lack of effort. It is usually a mismatch between the nature of melasma and the approach being taken to treat it. Melasma treatment in Sydney varies enormously in quality and philosophy, and the difference between a measured, cautious protocol and an aggressive one can be the difference between gradual improvement and a frustrating cycle of flare and rebound.

What is melasma, and why is it different from other pigmentation?

Melasma is a specific type of hyperpigmentation characterised by symmetrical, blotchy brown or grey-brown patches, most commonly on the cheeks, forehead, upper lip and chin. Unlike sun spots (solar lentigines) or post-inflammatory hyperpigmentation (PIH), melasma has a strong hormonal component, which is why it is sometimes called the "mask of pregnancy."

Understanding the key differences matters because the treatment approach needs to match the type of pigmentation:

• Sun spots (solar lentigines): Caused by cumulative UV exposure. Respond well to targeted laser and IPL. Tend to stay cleared once treated.
• Post-inflammatory hyperpigmentation (PIH): Caused by skin trauma (acne, burns, overly aggressive treatments). Fades over time with the right care.
• Melasma: Driven by hormones, UV exposure and heat. Has overactive melanocytes that are easily triggered. Can worsen with aggressive treatment. Requires ongoing management rather than a one-off fix.

This distinction is critical. If you treat melasma the same way you treat a sun spot, hitting it with high-intensity laser or deep chemical peels, you risk triggering the melanocytes further and creating a worse outcome than you started with. For more on how we differentiate pigmentation types, visit our pigmentation treatment page.

Why aggressive treatments backfire

Here is the frustrating paradox of melasma: the treatments that work brilliantly on other types of pigmentation can actively worsen it. High-intensity laser, aggressive IPL, deep TCA peels, and even overly frequent microneedling can all trigger what is known as post-inflammatory hyperpigmentation (PIH) in melasma-prone skin.

The mechanism is straightforward. Melasma skin has melanocytes (pigment-producing cells) that are already overactive and hypersensitive. When these cells are exposed to significant heat, inflammation or trauma, they respond by producing even more melanin. The result? A rebound effect where the treated area becomes darker than it was before treatment.

The single most important principle in melasma treatment is this: go slowly. The skin needs to be coaxed, not forced, into producing less pigment.

This does not mean laser is always wrong for melasma. It means that laser needs to be used judiciously, at very low settings, by a clinician who understands the difference between treating a discrete sun spot and managing a chronic, hormone-driven pigmentation condition.

The Eternity approach: cautious, layered, personalised

At Eternity, we treat melasma as a long-term management condition, not a problem to be solved in a single session. Our approach is built on three principles:

1. Reduce inflammation first

Before we even consider active treatments, we need to ensure the skin barrier is healthy and inflammation is under control. This often means simplifying your current skincare routine, introducing barrier-repair products, and ensuring your sun protection is genuinely adequate (SPF 50+ applied generously, every single day, even indoors near windows).

2. Layer treatments gradually

Once the skin is stable, we introduce treatments in a careful, stepwise manner. Depending on your melasma type and skin tone, this might include:

• Korean Byrzn vitamin infusion: A brightening and hydrating protocol that works from within the dermal layers, delivering antioxidants and melanin-inhibiting compounds without the trauma of aggressive external treatments.
• Gentle chemical peels: Low-concentration lactic acid or mandelic acid peels that encourage cell turnover without provoking the melanocytes. These are tightly controlled and never pushed to the point of visible peeling.
• Medical-grade skincare: Prescription-strength or clinical-grade formulations containing tyrosinase inhibitors, antioxidants and gentle retinoids that work on pigment production at a cellular level. We stock and recommend specific products through our skin treatments range.
• DEKA laser at low fluence: When appropriate, and only for certain melasma presentations, we may use our DEKA laser at very conservative settings. This is not the same as a standard pigmentation laser session. The energy levels are deliberately low, the passes are limited, and the goal is gradual improvement over multiple sessions rather than dramatic clearing in one hit.

3. Monitor and adjust continuously

Melasma treatment is not a set-and-forget protocol. We reassess your skin at every visit, adjusting the treatment intensity, spacing and active ingredients based on how your melanocytes are responding. If we see any sign of rebound, we scale back immediately and address the inflammation before continuing.

The maintenance reality: melasma is managed, not cured

This is perhaps the most important thing to understand about melasma, and the part that many clinics fail to communicate clearly. Melasma is a chronic condition. It can be significantly improved, often dramatically so. But in most cases, it requires ongoing maintenance to keep the pigment under control.

Hormonal fluctuations (pregnancy, contraceptive changes, menopause), seasonal UV changes and even heat exposure can all trigger a flare. The goal of treatment is not to promise a permanent cure, but to establish a management protocol that keeps the melasma at its lightest and most controlled state, with the tools and knowledge to intervene quickly if a flare occurs.

For many of our clients, this translates to quarterly or bi-annual maintenance treatments in clinic, combined with a consistent daily homecare routine.

Your homecare protocol: the daily essentials

In-clinic treatments account for perhaps 30-40% of your melasma outcome. The remaining 60-70% depends on what you do at home, every single day. Here is the protocol we recommend for most melasma clients:

Morning

• Gentle cleanser: No foaming agents or scrubs. Something that cleans without stripping.
• Vitamin C serum (15-20% L-ascorbic acid): A potent antioxidant that inhibits melanin production and protects against UV-induced pigmentation. Apply to clean, dry skin.
• Niacinamide (4-5%): Helps transfer less melanin to the skin surface. Works synergistically with vitamin C. Can be layered or found combined in one product.
• Moisturiser: Barrier-supportive, fragrance-free.
• SPF 50+ broad-spectrum sunscreen: This is non-negotiable. Tinted mineral formulations containing iron oxides offer additional protection against visible light, which can also trigger melasma. Apply generously and reapply every two hours if outdoors.

Evening

• Double cleanse: Oil or balm cleanser first (to dissolve sunscreen and makeup), followed by your gentle water-based cleanser.
• Active treatment (rotating): A prescription retinoid (tretinoin 0.025-0.05%) 2-3 nights per week, alternating with azelaic acid (15-20%) on the other nights. Both help regulate melanin production and promote cell turnover.
• Moisturiser: A richer, barrier-repair formula for overnight recovery.

For a comprehensive guide to building an effective skincare routine, including how to layer these actives safely, read our article on building a skin routine that actually works.

When to seek treatment vs when to wait

Not every moment is the right time to begin active melasma treatment. We generally advise waiting if:

• You are currently pregnant or breastfeeding (many active ingredients are contraindicated)
• You have recently had aggressive treatments that have left the skin inflamed or compromised
• You are heading into peak summer without adequate sun protection habits in place
• You are about to change hormonal medication (allow the skin to stabilise first)

Conversely, the ideal time to begin a melasma management protocol is during the autumn or winter months, when UV exposure is lower and the skin is less likely to be triggered during the early, more sensitive phase of treatment.

For evidence-based guidance on melasma and pigmentation disorders, the Australasian College of Dermatologists offers a range of patient resources.

Frequently asked questions