What is melasma?
Melasma is a chronic, relapsing pigment condition. Pigment cells become overactive, although their number does not rise. Patches are symmetric and sit in centrofacial, malar or mandibular areas. It is also called chloasma or the mask of pregnancy.
Triggers include ultraviolet and visible light, heat, infrared and hormonal influences such as pregnancy and hormonal contraception. Singapore lies about one degree north of the equator, so ultraviolet stays high all year. Dr Sin Yong assesses you himself and treats only once the diagnosis is firm.
Is melasma genetic?
Family tendency plays a part. In a 2009 survey of 324 women treated for melasma at nine clinics worldwide, about 48% reported a family history, nearly all in a parent, sibling or child [6]. Those answers were self-reported, and the survey had no comparison group.
A retrospective review of 561 patients given oral tranexamic acid at one Singapore centre found that those without a family history of melasma responded better [7]. Dr Sin Yong asks about family history at assessment. It does not decide the plan, but it helps set realistic expectations.
Can men get melasma?
Yes. Women are affected far more often, but men can develop melasma too, usually as the same mirror-image patches on the cheeks, forehead or upper lip. In the same Singapore review of 561 patients treated for melasma, 8.6% were men [7]. Sun, heat and family tendency drive it in men, and hormonal factors are reviewed as well. The assessment and the staged plan are the same.
Is melasma dangerous, and does it fade on its own?
No. Melasma is a harmless change in skin colour: it is not a cancer, it cannot pass to other people and it does not become something serious. What it affects is how you look and feel. The real risk is mislabelling, because a single dark spot that is new, changing, irregular or bleeding is not melasma and needs a doctor's dermatoscope check soon, whether or not you plan treatment.
Melasma that began in pregnancy or on hormonal medicine sometimes fades after delivery or a change of medicine. Established patches usually persist and darken again with sun and heat. See a doctor if patches keep spreading despite daily tinted sunscreen, if they darkened after a laser, peel or facial, or if a cream has left the skin red or thin.
How is melasma diagnosed?
Patches are examined in daylight-balanced and angled light, with dermoscopy and a Wood's lamp where needed. Depth is classed as epidermal, dermal or mixed. Melasma is then separated from sun spots, post-inflammatory marks, freckles and Hori's naevus, because these need different care. A changing, raised or unusual patch is referred for dermatological assessment.
Is my melasma epidermal, dermal or mixed?
Depth is judged at examination with a Wood's lamp and dermatoscope, not from a photograph, and it sets the pace of the plan.
| Depth | How it looks | What it means for the plan |
|---|---|---|
| Epidermal | Brown, with sharper contrast under the lamp | Creams and sun protection act at this level |
| Dermal | Grey-brown, with blurred edges | Pigment sits deeper and is held longer, so the plan is slower and avoids heat |
| Mixed | Features of both | Both layers are planned for, at the slower pace |
What does melasma treatment in Singapore include?
Tinted iron-oxide sunscreen, shade and avoiding heat form the base of the plan.
Hydroquinone in supervised cycles with planned breaks, and tretinoin.
Available as a topical cream. The oral form is prescription-only and considered after clotting-risk screening.
Pico toning or 1064 nm toning at low fluence, staged, with settings chosen for Fitzpatrick III to V skin.
R2 Glow uses long-pulsed 755 nm and 1064 nm.
How Dr Sin Yong stages melasma treatment
Dr Sin Yong adds one layer of care at a time and reads it at review before building on it. The order stays the same for everyone, and the pace follows your skin.
“I manage it the way the evidence says: light control, topicals, patience, and gentle energy in its supporting role — with maintenance planned from day one.”
What do Koreans do for melasma?
Practice varies between clinics in Korea, as it does in Singapore. Korea is where low-fluence laser toning, a gentle 1064 nm approach now used widely for pigment, was developed and popularised. Here, toning is one optional step, not the starting point. It comes after diagnosis, sun and heat control and creams, at low energy, with a defined stop point. A 2022 review of low-fluence Q-switched toning for melasma reported mottled pale patches that occasionally persisted [1]. Laser toning explains the method.
Who this suits
It suits symmetric brown-grey patches confirmed as melasma, especially pigment that persists despite sunscreen alone. You need to be willing to combine trigger control, daily protection and topical care. You also need to accept a staged plan with reviews. If the diagnosis changes, the approach changes with it.
Who should wait or take care
Elective laser is generally deferred. Hydroquinone, tretinoin and oral tranexamic acid are usually avoided.
A personal or family history of blood clots or a clotting disorder matters. Smoking and combined hormonal contraception are reviewed before oral tranexamic acid.
Photosensitising medicine, a recent tan, active dermatitis, or irritation from strong actives.
Known allergy to a topical ingredient.
Laser is not started.
This is a poor fit if you want one-off clearance, or cannot keep up daily protection and heat avoidance.
Can melasma be removed, and what can treatment not do?
It is managed over time, and relapse is possible.
Pigment can return after a hot season, a pregnancy or a change of hormonal medicine.
Pico laser is an adjunct only. It does not control melasma.
Risks and side effects
Aggressive or heat-based laser can cause rebound darkening. Repeated low-energy toning of one area has been linked to pale, mottled spots that recover slowly. Irritation can leave post-inflammatory pigment. Creams can cause irritation, redness and peeling. Prolonged unsupervised hydroquinone can cause a bluish-grey darkening called exogenous ochronosis. Oral tranexamic acid can cause stomach upset, lighter periods and, rarely, blood clots. Adverse effects are mostly transient, but a deep vein thrombosis has been reported in a patient later found to have an inherited clotting disorder.
What recovery looks like
What can you do at home for melasma?
Most melasma care happens at home, with a doctor setting the plan. Prescription creams, tablets and any device need a doctor. Lightening creams from salons or online sellers may contain undeclared steroids or hydroquinone, so bring any you use to your consultation.
| Area | At home | Why it matters |
|---|---|---|
| Light | A tinted sunscreen with iron oxides every day, indoors too, with shade and a hat | Visible light and ultraviolet light both drive melasma |
| Heat | Fewer saunas, hot classes and steam rooms | Heat can set off melasma even without sun |
| Friction | No scrubs, rough towels or picking | Rubbing can deepen melasma |
| Gentle brighteners | Azelaic acid, niacinamide or vitamin C as support | They support a plan; they are not the plan |
| New products | One at a time, stopping anything that burns | Irritation can add post-inflammatory marks |
How is melasma maintained?
Daily sun protection carries on indefinitely, with reapplication and protection near windows indoors. Hydroquinone is stopped in a planned way. Azelaic acid, a retinoid or tranexamic acid may be used between courses. Reviews look for rebound, irritation and pale patches, and revisit hormones and heat.
How many melasma sessions will I need?
The number of sessions and their spacing are discussed at consultation. Fees follow your plan, not a fixed list. They depend on assessment findings, the area involved, whether approaches are combined and how the plan is staged. A written quote is given at consultation, after assessment and before anything is agreed.
How much does melasma treatment cost in Singapore?
The fee is given after assessment, because melasma is planned person by person, and some plans include no laser at all. No figure is published, and one given before examination would not describe your skin. You receive a written quote before anything is agreed.
| What affects the fee | Why |
|---|---|
| What the assessment finds | Epidermal, dermal and mixed melasma are planned differently, and other pigment may sit alongside |
| The area | A patch on the cheeks differs from a wider pattern across the face |
| Creams and tablets | Which prescription agents are used, and for how long |
| Any in-clinic step | Whether R2 Glow or toning is added at all |
| Review and maintenance | How often progress is reviewed |