Melasma: why it happens and why it comes back

Key takeaways

• Melasma is common in women with brown skin, usually starting between 20 and 40, and often linked to pregnancy or the pill.
• Sunlight and visible light are the main triggers to control. Heat may also worsen it.
• There are surface, deep and mixed types. Deep pigment responds slowly.
• It is chronic. Patches often darken in summer and with lapses in sun protection.
• Aggressive treatment can make melasma worse, so a careful, long-term plan matters.

What is melasma?

In Marathi and Hindi many patients call it "vaang" or "jhaiyan". Medically it is melasma, sometimes called chloasma, or the "mask of pregnancy".

It shows up as patches, usually on both sides of the face, in a fairly symmetrical pattern. The American Academy of Dermatology describes them as tan, brown, grey-brown or bluish-grey, typically on the cheeks, forehead, chin and above the upper lip. It is not contagious and it is not cancer.

DermNet describes it as more common in women, usually starting between 20 and 40, and most often in medium-brown skin types, which describes a large share of Indian women.

What causes melasma?

That is very important to understand: there is no single cause. Melasma happens when several things line up in someone who is already predisposed.

• Genes. DermNet notes that around 60% of people with melasma report affected family members. If your mother had it, your risk is higher.
• Ultraviolet light. Sun exposure triggers and darkens it.
• Visible light. Ordinary daylight, not only UV, contributes to pigmentation in brown skin. This is why melasma can persist even in people who rarely go out.
• Hormones. Pregnancy, contraceptive pills and hormone therapy can trigger it. Thyroid disorders have also been linked.
• Heat and infrared. The Indian Sunscreen Forum's 2025 consensus notes that infrared can aggravate melasma, and suggests people working near heat, such as in hot kitchens, may need extra protection.
• Irritation. Scented products and phototoxic reactions can contribute.

See, what happens is, the pigment cells in melasma skin are switched to "high". Each trigger nudges them further. Remove one trigger and the others still keep them active. That is why melasma is managed, not cured with one cream.

What are the types of melasma?

DermNet describes three types, based on where the pigment sits:

Your doctor will usually diagnose melasma by looking carefully, often with a magnifying light. A biopsy is rarely needed.

Why does melasma keep coming back?

This is the question every melasma patient eventually asks me, often with some frustration. "Doctor, it went, and now it's back."

There are three reasons: 1. The tendency stays. Treatment fades the pigment you can see. It does not change your genes or the sensitivity of your pigment cells. 2. Triggers return. Summer, a holiday, a few weeks without sunscreen, starting a pill, a pregnancy. The American Academy of Dermatology notes patches often look darker in summer and lighter in winter, and that unprotected sun can bring them back. 3. Over-treatment. Strong peels, lasers or irritating creams can inflame the skin and switch pigment back on. DermNet warns that lasers and light devices carry a high risk of relapse and of making melasma harder to treat.

Basically, I think of melasma like blood pressure. You bring it under control, and then you keep it under control.

Who is more likely to get melasma?

• Women, especially in their 20s to 40s
• Medium to dark skin tones, which includes most Indian skin
• People with a family history
• Women who are pregnant or on hormonal contraception or hormone therapy
• People with a lot of daily sun or heat exposure: commuting, outdoor work, cooking over a hot stove

Men can get it too, though less often.

If several of these apply to you, that does not mean melasma is certain. It means prevention is worth starting early: daily tinted sunscreen, a hat on the commute, and getting new patches checked while they are still light and easier to manage.

Can melasma go away on its own?

Sometimes. The American Academy of Dermatology notes that melasma may fade after pregnancy or after stopping a contraceptive pill. But it can also last for years. If it is still there several months after the trigger has gone, it is unlikely to fade fully without treatment and protection.

What does managing melasma look like?

I explain treatment in detail in treating melasma safely in Indian skin. In short: - Daily broad-spectrum sunscreen, ideally tinted with iron oxide, applied generously and reapplied when outdoors - A hat or umbrella, and shade during strong sun - Prescription creams that lower pigment, used under supervision - Sometimes oral medicines, after checking your medical history - Gentle in-clinic procedures, only where they add benefit - A long-term maintenance plan

Melasma is not the same as dark marks after pimples or a sun tan. If you are not sure what you have, read uneven skin tone: causes and treatments.

How we approach this at Dr Tvacha

Melasma needs a careful diagnosis first, because some other pigment conditions look similar, and the type of melasma changes the plan. At our centres in Thane, Andheri, Bandra and Dahisar, the Rs 499 skin consultation covers your history, triggers and skin type. The plan, including maintenance, is written down with fees before you pay. You can read about the Second Layer Skin Plan, or find a centre near you.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.