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Melasma
Melasma is one of the most common skin concerns in Indian women and one of the most frequently undertreated, because the majority of patients manage it with over-the-counter creams that address the symptom superficially without understanding the mechanism driving it. Facial pigmentation in Indian skin is a complex problem: darker Fitzpatrick skin types (IV–VI) produce more melanin more readily, respond more aggressively to UV exposure and hormonal triggers, and are more prone to post-inflammatory hyperpigmentation from treatments that are too aggressive.
At Shree Hospitals, our melasma treatment in Mumbai is built around this reality combining evidence-based combination depigmentation therapy with rigorous sun protection for melasma and realistic expectation setting, because melasma is controlled, not cured.
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Our Approach
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Our Approach in Managing Melasma
Shree Hospitals — Life-saving care
The single most common reason melasma fails to respond to treatment is inadequate sun protection. No depigmenting cream works when melanocytes are being continuously stimulated by UV radiation. Our melasma specialist dermatologist team in Mumbai, India addresses this sequence from the start: sun protection first, depigmenting therapy second and both maintained simultaneously and indefinitely.
- Clinical Assessment & Depth Classification
Melasma depth determines which treatments will work
- Wood's lamp examination — epidermal melasma: pigmentation enhanced under Wood's lamp; dermal melasma: pigmentation not enhanced; mixed: partially enhanced
- Dermatoscopy : pseudoreticular network, pigmented follicular openings, and telangiectasia guide depth assessment and treatment response monitoring
- Melasma Area and Severity Index (MASI) : quantifies forehead, right malar, left malar, and chin involvement; baseline for treatment monitoring
- Clinical pattern: centrofacial (most common cheeks, forehead, nose, upper lip), malar, mandibular
- Trigger history: oral contraceptive pills, pregnancy (chloasma), HRT, sun exposure, hypothyroidism
- Sun Protection : The Foundation That Cannot Be SkippedSun protection for melasma is not a recommendation .it is half the treatment.
- Broad-spectrum sunscreen SPF 50+ with UVA-PA+++ rating applied 20 minutes before sun exposure; reapplied every 2–3 hours outdoors
- Tinted sunscreen iron oxide-containing formulations protect against visible light, which independently stimulates melanocytes in melasma
- Physical blockers (zinc oxide, titanium dioxide) preferred over chemical sunscreens in sensitive post-procedure skin
- Sun-protective behaviour wide-brimmed hats, UV-protective clothing, avoiding peak sun hours (10am–4pm)
- Indoor UV exposure glass-filtered UVA and blue light from digital screens both stimulate melanocytes; tinted sunscreen indoors is not excessive in melasma patients.3.Topical Depigmentation TherapyCombination depigmentation therapy consistently outperforms monotherapy in melasma.
- Hydroquinone 2–4% the most studied depigmenting agent; inhibits tyrosinase; used for 3–6 months; avoid prolonged use (>6 months continuous) due to ochronosis risk in Indian skin
- Triple combination cream (Kligman's formula) Hydroquinone 4% + Tretinoin 0.05% + Fluocinolone acetonide 0.01%; the most effective single formulation for epidermal melasma; limited to 8-week courses due to steroid component
- Kojic acid tyrosinase inhibitor; gentler alternative to hydroquinone; used as adjunct or in hydroquinone-intolerant patients
- Tranexamic acid topical and oral formulations; inhibits UV-induced keratinocyte-melanocyte interaction; particularly effective in Indian skin with minimal side effects
- Azelaic acid 20% anti-inflammatory and tyrosinase-inhibiting; safe in pregnancy; useful for sensitive skin
- Niacinamide 5% reduces melanosome transfer from melanocytes to keratinocytes; well-tolerated; useful as maintenance agent
- Retinoids (Tretinoin, Adapalene) accelerate epidermal turnover, reduce melanin transfer; significant photosensitivity risk — night use only; not in pregnancy
4.Procedural Treatments
Procedures are adjuncts to topical and sun protection therapy not substitutes.
- Chemical peels Glycolic acid (20–70%), Mandelic acid, Salicylic acid, Lactic acid; series of 4–8 peels at 2–4 weekly intervals; superficial peels preferred in facial pigmentation in Indian skin to avoid post-inflammatory hyperpigmentation
- Q-switched Nd:YAG laser (1064nm) low-fluence toning sessions; reduces dermal melanin; effective for mixed and dermal melasma; multiple sessions required; risk of rebound pigmentation if UV exposure not controlled
- Tranexamic acid injections (intradermal microinjections) effective for melasma resistant to topicals; typically 6–8 sessions monthly
- PicoSure laser emerging; picosecond technology reducing thermal injury and PIH risk compared to nanosecond lasers; better tolerability in darker skin types
5.Hormonal Trigger Management
- Oral contraceptive pill : a significant melasma trigger; switching to progestin-only pill, non-hormonal, or IUD contraception often reduces melasma activity
- Pregnancy melasma (chloasma) often improves postpartum; azelaic acid is the only safe depigmenting agent in pregnancy; hydroquinone and retinoids contraindicated
- HRT : estrogen-containing HRT worsens melasma; transdermal or progestin-only alternatives discussed with gynaecology
6.Maintenance Therapy
Melasma recurs when treatment stops and sun protection lapses. Maintenance is indefinite
- Maintenance depigmenting agents: Niacinamide, Kojic acid, Azelaic acid, low-dose retinoids
- Year-round SPF 50+ sunscreen non-negotiable even in winter and overcast conditions
- Annual MASI scoring tracks stability and guides whether procedural treatments are needed
- Patient education understanding that melasma management is a long-term commitment, not a course of treatment
Happy Patients & Their Case Stories
A professional woman with bilateral malar melasma for three years — treated with multiple OTC fairness creams without improvement. MASI was 14. She was on a combined OCP. At Shree Hospitals, contraception was switched to a copper IUD, a tinted SPF 50+ sunscreen was prescribed for morning and afternoon reapplication, and a triple combination cream was started for 8 weeks.
Mrs. Meena R.
Presented with persistent melasma unresponsive to hydroquinone — malar and centrofacial mixed pattern on Wood's lamp. Tranexamic acid 250mg twice daily was added to her topical regimen alongside Q-switched Nd:YAG laser toning at monthly intervals. Strict tinted sunscreen use was reinforced. At 9 months, MASI had reduced from 18 to 5. Maintenance tranexamic acid and azelaic acid were continued.
Mrs. Kavitha S.
How to Identify Melasma ?
Melasma has a characteristic distribution and appearance that distinguishes it from other pigmentation conditions.
Features pointing toward a melasma diagnosis
- Symmetrical brown to greyish-brown patches on the cheeks, forehead, bridge of the nose, upper lip, or chin
- Patches with irregular, feathery borders not well-defined like post-inflammatory hyperpigmentation
- Gradual onset over weeks to months not sudden like drug reactions or PIH
- Worsening in summer and improving (partially) in winter UV-driven pigmentation fluctuation
- Onset coinciding with OCP initiation, pregnancy, or hormonal therapy a strong diagnostic clue
- Facial pigmentation in Indian skin that darkens within hours of sun exposure melanocyte hypersensitivity
- Predominantly affects women (90% of melasma cases) male melasma occurs but is less commonThe distinction from other pigmentation conditions post-inflammatory hyperpigmentation (PIH), drug-induced pigmentation, lichen planus pigmentosus requires clinical examination and sometimes Wood's lamp or dermoscopy. PIH has a clear precipitating event and is more commonly darker and sharper in outline; melasma is chronic, hormonally associated, and Wood's lamp-responsive in epidermal cases. Seek melasma treatment in Mumbai from a dermatologist who classifies depth before prescribing, because treating dermal melasma with superficial peels alone produces minimal improvement and patient frustration.
Important FAQs: Melasma
Will my child grow out of eczema?
Approximately 60% of children with atopic dermatitis improve significantly by adolescence. However, 30% continue into adulthood, and some adults develop eczema for the first time. It is not reliably outgrown.
Is Dupilumab safe for long-term use?
Dupilumab has one of the best safety profiles of any biologic in dermatology no requirement for blood test monitoring, no immunosuppression risk, no organ toxicity. It is approved for use from 6 months of age.
Can atopic dermatitis be triggered by food?
In children under 5 with severe AD, food allergy particularly egg, milk, wheat, and peanut can worsen disease. Food elimination without confirmed allergy testing is not recommended and risks nutritional deficiency.
Why does eczema get worse at night?
A serious complication where herpes simplex virus infects eczematous skin producing widespread painful blisters, fever, and malaise. It requires urgent systemic Acyclovir treatment and is a medical emergency.
Is bleach bath therapy safe for eczema?
Dilute sodium hypochlorite baths (0.005% — approximately 1 teaspoon of household bleach in a standard bath) reduce Staphylococcal colonisation and infection rates. Evidence supports twice-weekly use in children with moderate-severe AD prone to skin infections.
Treatments For Melasma At Shree Hospitals
Treatments for Melasma at Shree Hospitals.Comprehensive pigmentation treatment and skin brightening in Mumbai combining topical, procedural, and sun protection strategies
Top Melasma & Pigmentation Specialists in Mumbai
Dr. Snehal Thank
Pioneer Pediatric Physiotherapist & Neuro-Developmental
Dr. Yogesh Kalyanpad
Dermatology, Cosmetology and Hair Transplant
Every doctor and specialist at Shree Hospitals is board-certified and brings an average of 15 or more years of clinical experience in their area of subspecialty.
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