Melasma in Wrocław: diagnosis, treatment and control of relapses
Brown or grey-brown patches on the face should not be qualified for a procedure on the basis of their colour alone. At HappyDERM the doctor first identifies the type of pigmentation, assesses the aggravating factors and the risk of post-inflammatory pigmentation, and then draws up a long-term plan of treatment and sun protection.
What does melasma look like and what can it be confused with?
Melasma is a chronic and relapsing hyperpigmentation. It most often forms irregular but fairly symmetric patches on the cheeks, the forehead, the nose, above the upper lip or on the chin. The lesions are flat and usually neither painful nor itchy. A similar description from a patient may, however, apply to several different diseases or to the consequences of inflammation.
Melasma
It usually has a diffuse, symmetric distribution on the face and a clear connection with exposure to light. It often occurs in women, but it may affect anyone.
Post-inflammatory pigmentation
It appears after acne, eczema, an injury, irritation or a procedure. The cause of the inflammation has to be brought under control first and the skin barrier protected.
Sun spots
Solar lentigines are usually better demarcated than melasma. The doctor distinguishes them from melasma, because they may require a different kind of treatment.
Actinic keratosis
A rough, scaling or recurring patch may be a lesion connected with chronic sun damage. It should not be lightened on your own; after a diagnosis the doctor may choose a different kind of treatment, including cryotherapy in selected cases.
A pigmented lesion
Asymmetry, several colours, growth, bleeding or clear evolution require the assessment of a mole. A laser and a peel do not replace dermoscopy.
Drug-induced or contact pigmentation
Medicines taken, cosmetics, fragrances and chronic irritation may matter. The history helps to separate these causes from melasma.
Report a lesion before a procedure if it is unilateral, raised, rough, forms a crust, bleeds, is painful or itchy, or quickly changes shape or colour. Priority then goes to dermoscopic diagnosis, not to a lightening procedure.
What may provoke or aggravate melasma?
There is no single cause common to all patients. Sunlight matters most, but the doctor also takes into account hormones, the skin phototype, family occurrence, medicines, earlier procedures and the tolerance of the skin.
UV radiation and visible light
Sun exposure may deepen the pigmentation and favour relapses. The high-energy part of visible light may also matter. There is, however, no evidence that ordinary blue light from a telephone or a monitor causes melasma of the skin.
Pregnancy and hormonal factors
Melasma may appear in pregnancy or during hormonal treatment. Do not stop contraception or therapy recommended by another doctor on your own; a joint assessment of the benefits and the risks is needed.
Phototype and predisposition
Melasma more often affects people who tan easily and it may run in families. A darker phototype requires particular caution with procedures because of the risk of post-inflammatory pigmentation.
Inflammation and irritation
Excessive exfoliation, frequent changes of cosmetics, a burn or too intensive a procedure may sustain inflammation and pigmentation. Stronger does not always mean more effective.
How does the dermatologist build a plan of treatment for melasma?
The diagnosis is often clinical. In selected situations the doctor may use a dermatoscope or a Wood’s lamp and, with an atypical picture, propose further diagnosis. The plan depends on the phototype, the depth and extent of the pigmentation, pregnancy or breastfeeding, medicines, earlier reactions and the effect of the lesions on everyday life.
Confirming the diagnosis
The doctor examines the whole face and the areas exposed to the sun, compares the symmetry and asks about the onset of the lesions, their seasonality, pregnancy, hormones, medicines, cosmetics and earlier procedures.
Sun protection and limiting irritation
This is part of the treatment, not an addition. Broad-spectrum UVA/UVB protection, mechanical cover and a way of reapplying it that can be maintained are chosen. A tinted preparation with iron oxides may increase protection against visible light.
Dermatological treatment
The doctor may choose substances that limit the formation of pigment, regulate the renewal of the epidermis or reduce inflammation. The composition, the order and the duration of use depend on the skin; some therapies require a prescription and monitoring.
Assessment of the effectiveness and tolerance of the treatment
We assess the tolerance, the degree of lightening, new lesions and adherence to sun protection. An absence of improvement, intense burning or darkening is a reason for a new diagnosis, not for increasing the intensity on your own.
In pregnancy and during breastfeeding the choice of therapy must be separate. Some lightening medicines and retinoids are not appropriate then. The safe range of skin care, sun protection and any treatment is set by the doctor after taking a history.
What does a consultation about pigmentation at HappyDERM look like?
A good consultation does not begin with the choice of a device. First we put in order the history of the lesions and all the factors that may affect the pigment and the tolerance of treatment. It is worth bringing photographs of the face from different seasons, the names of the preparations and medicines used and information about earlier peels, lasers or post-procedure reactions.
History and time course
We establish when the patches appeared, whether they darken in summer, how they behaved in pregnancy or during hormonal therapy and what has helped or irritated the skin so far. Chronic diseases and a full list of medicines also matter.
Examination of the skin
The doctor examines the pattern of the pigmentation, the borders and the surface of the lesions and the condition of the skin barrier. If necessary, additional diagnostic tools are used. If the picture raises doubt, an aesthetic procedure is postponed until the diagnosis is clarified.
The patient’s priorities
We discuss the expected scope of improvement, the time available for healing, daily exposure to the sun and readiness for regular sun protection. The plan must not only be medically justified but also possible to maintain.
What to do before the visit?
Do not introduce new, intensively exfoliating cosmetics a few days before the consultation and do not try to “test the reaction” of the skin with an acid at home. If possible, come without covering make-up or be prepared to remove it during the examination. Do not stop prescribed medicines. Write down the names of the preparations, the frequency of use and any adverse effects, because the phrase “a serum for pigmentation” does not tell the doctor which substance was in contact with the skin.
How do we assess change over time?
Follow-up photographs should be taken in as similar light as possible, without a filter and with the face in a similar position. What is assessed is not only the degree of lightening but also the tolerance, new lesions, redness and the effect of the treatment on the comfort of the skin. In this way the decision to continue, modify or end a stage rests on the real response, and not solely on the impression of a single day.
A peel, microneedling, light or a laser?
A procedure may be an addition to treatment, but it should not replace sun protection and a well-tolerated dermatological therapy. The most recent international consensus indicates that lasers should be considered mainly for resistant cases. In melasma the result of a device is often variable, and too much inflammation may deepen the pigmentation.
A medical peel
It may support the therapy in a properly qualified person. The depth, the substance, the phototype and the post-procedure care affect the risk of irritation, hypopigmentation, hyperpigmentation or a scar.
Microneedling
It may be considered as a supporting method, but it requires control of the depth and asepsis. Pain, swelling, infection, scarring and post-inflammatory pigmentation are possible.
Lasers and light technologies
They are not an automatic first choice. The doctor assesses the kind of patch, the phototype, the treatment so far and the risk of relapse. Redness, swelling, a burn, hypopigmentation and an increase in pigmentation are possible.
We do not offer “one procedure for every patch”. If the picture does not correspond to melasma, the plan may cover non-laser methods of treatment, including cryotherapy for properly diagnosed lesions, the treatment of inflammation or further diagnosis. The choice is decided by the diagnosis, not by the expected name of a procedure.
Why are follow-up and maintenance treatment beneficial?
Melasma has a tendency to relapse, so regular assessment of the skin may be more important than repeating the same procedure. Follow-up makes it possible to compare photographs in similar light, to detect irritation, to assess new aggravating factors and to change the plan before unnecessary escalation occurs.
Elements of maintenance treatment
These include regular sun protection, gentle skin care and the treatment recommended by the dermatologist. Maintenance is intended to limit the appearance of new pigmentation and to help preserve the improvement obtained.
Procedures only after renewed qualification
Not a peel, microneedling or a device merely because a certain time has passed. Every further stage requires an assessment of the tolerance, the benefit and the risk.
When to take a break from treatment?
A break and a consultation are worth considering with burning, scaling, an increase in redness, new pigmentation or prolonged healing. The irritation of the skin has to be reduced first and the diagnosis assessed again.
When to change the method of treatment?
A change of method may be needed when the dominant problem is no longer melasma but post-inflammatory pigmentation, dilated vessels, an uneven surface of the skin or an active dermatosis. Further treatment should follow from the current diagnosis.
Melasma: the most frequent questions before a consultation
Is melasma dangerous?
Melasma itself is a benign disorder of pigmentation and does not turn into a cancer. The problem is that a patient may call another lesion melasma. An atypical patch has to be diagnosed first.
Are melasma and a sun spot the same thing?
No. Melasma usually has a diffuse and symmetric distribution, while a solar lentigo is more often single and demarcated. The diagnosis affects the choice of treatment and the assessment of risk.
Does light from a telephone or a monitor cause melasma?
There is no evidence that the blue light emitted by personal electronic devices affects the skin in that way. High-energy visible light from sunlight may matter.
Will sunscreen alone remove the pigmentation?
Sun protection may limit darkening and support treatment, but in some people it is not enough to lighten established melasma. The dermatologist may choose additional treatment.
Is a laser the best method?
There is no single best method for everyone. Lasers and light technologies are considered cautiously, more often after an insufficient response to basic treatment, because relapses and a worsening of the pigmentation are possible.
Can a peel make melasma worse?
Yes, particularly when it is too intensive, not matched to the phototype or applied to irritated skin. That is why the procedure requires qualification and a plan of post-procedure care.
Can melasma be treated in pregnancy?
The scope is limited and some medicines cannot be used. The basis is safe sun protection and gentle skin care; every preparation or procedure has to be agreed with the doctor.
Should hormonal contraception be stopped?
Not on your own. A time connection with hormones is worth discussing with the dermatologist and with the doctor in charge of the contraception, taking into account its purpose and the alternatives.
How quickly will improvement appear?
That depends on how long the lesions have been present, the depth of the pigment, the phototype, the tolerance of treatment and the exposure to light. An honest plan assumes gradual assessment, not a guarantee of a particular date.
Can melasma come back?
Yes. It is a relapsing disease. Sun protection and individual maintenance treatment may reduce the risk, but they do not guarantee a permanent absence of lesions.
Are blood tests needed in melasma?
Not routinely in everyone. The doctor orders tests when the history or other symptoms suggest an additional problem, for example a hormonal disorder or the effect of medicines.
When is dermoscopy needed?
When the picture is not typical, the patch is single, it is changing or it has to be distinguished from a mole, an actinic keratosis or another lesion. The doctor decides on the need for the examination after looking at the skin.
What is the information for patients based on?
- American Academy of Dermatology: diagnosis and treatment of melasma
- British Association of Dermatologists: patient information leaflet, 2024
- International Delphi consensus on melasma management, 2026
- Systematic review of self-applied topical interventions and photoprotection
- Latin American consensus on the treatment of melasma
The content is educational and does not replace an examination or individual medical recommendations.
Consultation about pigmentation — the diagnosis comes first
Bring to the consultation a list of medicines and cosmetics, information about pregnancy or hormones and photographs showing the seasonal changes in colour. Do not stop treatment and do not have an intensive peel directly before the visit.