Melasma & Pigmentation: Why It Keeps Coming Back (And How to Stop It)

Melasma is the skincare concern that frustrates patients and dermatologists alike — because it has a maddening tendency to return. Understanding why it comes back is the key to finally controlling it.

What is Melasma?

Melasma is a form of hyperpigmentation caused by overactive melanocytes (pigment-producing cells) triggered by UV exposure, hormonal changes, and heat. It typically appears as symmetrical brown or grey-brown patches on the face — most commonly on the cheeks, upper lip, forehead, and nose bridge. It's particularly prevalent in Indian women with Fitzpatrick skin types III–V.

Why Does It Keep Coming Back?

Most melasma treatments target the visible pigment — but leave the underlying overactive melanocytes intact. Without addressing the root cause (and crucially, without rigorous sun protection), pigment returns within weeks to months of treatment. This is why melasma requires a maintenance strategy, not a one-time treatment.

The Protocol That Works

Sun protection (non-negotiable): SPF 50+ with PA++++ rating, applied every 2 hours when outdoors. No treatment will hold without this. Iron-oxide-containing sunscreens additionally protect against visible light, which also triggers melasma.

Topical depigmenting agents: Prescribed combinations of Tranexamic acid, Kojic acid, Azelaic acid, and Vitamin C work to suppress melanocyte activity while active treatment proceeds.

Q-Switch Nd:YAG Laser (low fluence): Gentle laser toning shatters existing pigment clusters and suppresses melanocyte activity without triggering post-inflammatory hyperpigmentation. 6–8 sessions, fortnightly.

Chemical Peels (glycolic / lactic): Accelerate cellular turnover and help pigment to shed faster when used as an adjunct to laser.

Oral Tranexamic acid: An underused but highly effective adjunct — oral tranexamic acid significantly reduces melanocyte stimulation from within, helping to prevent recurrence.

The Bottom Line

Melasma can be controlled — but it requires a committed, multi-pronged approach and a dermatologist who understands its nuances. At Tru Glow, we have refined our melasma protocol over thousands of patients and consistently achieve lasting, visible clearing that patients maintain with simple monthly maintenance sessions.