"How do I treat Melasma?"

Melasma is not a ‘cosmetic’ problem – it’s an actual skin disease: I define a skin disease as anything that represents an abnormality in the skin, when it doesn’t look the way it should. (see my post on ‘Butt Skin’). Melasma, basically, is too much pigment in the skin and we still don’t really know the exact cause.

Unfortunately, Big Skincare is trying to make you believe that melasma can be treated with a set of over the counter cleansers, serums and moisturisers you can purchase at your local beauty counter or ‘medispa.’ And that is categorically and absolutely a lie. No over the counter cosmetic product or series of products will treat your melasma. It is a skin disease and needs a medical treatment. Melasma is one of those skin conditions that you should see a Consultant or Board-Certified Dermatologist about. Do not DIY this with the help of the ‘friendly’ ladies at the beauty counter or a beautician. You will waste tons of money and not get anywhere.

And please don’t ask me ‘what about kojic acid? Glycolic acid? Arbutin? Vitamin C? Niacinamide? I was told those work really well for pigmentation.’ They don’t.

So how do I get great results with my patients? First I get them to stop using all cosmetic skincare except the absolute basics (no surprise there, right?). Then usually I start them on a compounded prescription product targeted at melasma with medication that we know actually removes pigmentation safely from the skinand give them extremely specific instructions on how to use the treatment appropriately. And it works. See my unfiltered and unedited patient before and afters on my feed.

Often I add in oral tranexamic acid if not contraindicated. I also counsel them about strict sun avoidance tactics. And then we wait. There is no overnight magic. My patients trust me and we go through the treatment together. And it works. No 5-step skincare regime costing hundreds of pounds or series of laser treatments. Correct diagnosis, evidence-based management plan, consistency and patience. That’s the magic melasma treatment combo. And before you ask: yes, hydroquinone when used appropriately under medical supervision is absolutely safe.

For more info see my paper in the Journal of Cosmetic Dermatology (2019) DOI: 10.1111/jocd.13182