Possible Melasma: Sunlight, Visible Light and a Useful Consultation

Confirm what the pigmentation is

Melasma commonly appears as brown or grey-brown patches, often symmetrically on the cheeks, forehead, nose or upper lip. Similar-looking changes can have other causes. A clinician may use history, examination and sometimes a Wood's lamp or other assessment; symmetry alone is not a diagnosis.

Bring photographs showing onset and change, plus a list of medicines, pregnancy or hormonal context, treatments and sun exposure. Seek prompt assessment for a patch that is evolving, bleeding, crusting or unlike the surrounding pattern rather than treating it as cosmetic pigmentation.

Light exposure is more than a beach day

AAD guidance emphasises daily sun protection because sunlight can trigger melasma and undo improvement. Choose broad-spectrum SPF 30 or higher sunscreen, and reapply as directed outdoors. A tinted sunscreen with iron oxide can help protect against visible light, which may worsen melasma.

For Hong Kong residents and visitors, exposure includes walking between meetings, ferry decks, hiking and sitting near bright windows. Use shade, hats and clothing as well. These measures support management but cannot guarantee that pigmentation will never recur.

Keep the routine gentle enough to continue

Irritation can make pigmentation more noticeable. Use a mild cleanser, moisturiser and tolerable sunscreen before adding treatment. Stop products that burn or sting persistently. Avoid combining a peel, retinoid and multiple acids in pursuit of faster change.

Treatment may involve prescription medicines, chemical peels or device-based procedures, but choice depends on diagnosis, skin response, medical history and risk. Pregnancy changes what is appropriate. No responsible consultation should promise a single permanent cure or use ethnicity as a shortcut for treatment selection.

Ask questions that expose the plan

Ask what diagnosis is being treated, which alternatives were considered, what evidence supports the proposal, expected timescale, common adverse effects, pregnancy precautions, aftercare and what happens if pigmentation worsens. For a procedure, ask who performs it and how complications are managed.

Take baseline photographs under consistent light and measure progress over months rather than day to day. A plan should include maintenance and relapse management, not only the first treatment session.

Common questions