Melasma is a brown pigmentation of the face, mostly on the cheeks, forehead and upper lip. It mainly affects women, often after pregnancy or while on contraception, and the sun makes it worse. It can be controlled but not cured for good: in Marrakech, where the sun is strong nearly all year, sun protection matters as much as the products. Dr Sara Zahid, a dermatologist in Guéliz, first confirms the diagnosis, because other facial spots look like it without being treated the same way. She then builds a careful treatment, especially on olive skin where the risk of rebound is high.
Hormones (pregnancy, the pill, hormonal treatments), the sun and a personal predisposition combine. Visible light, not only UV, also keeps pigmentation going. Some skins, often olive ones, are more exposed. Melasma is sometimes linked to irritating cosmetics or to repeated heat on the face.
This is the foundation. A high-SPF sunscreen applied in the morning and renewed, a hat, sunglasses, and attention to the intense light of the afternoon. A tinted screen also protects against visible light. Without this, no treatment holds: one day in the sun is enough to undo weeks of care.
Depigmenting creams prescribed individually, with close follow-up to adjust doses and avoid irritation, are the core of treatment. In some cases, an oral treatment (tranexamic acid) can be discussed, after checking for contraindications. Melasma responds slowly: several weeks before any lightening begins.
A badly chosen laser can make melasma worse, hence great caution. When it is judged useful, it comes once the condition is stable, with low-energy Q-Switch or picosecond lasers, in spaced sessions, and never replaces sun protection or underlying treatment. Powerful ablative lasers are to be avoided on melasma.
A brown facial spot can also be a sun lentigo, post-inflammatory pigmentation, a Hori nevus or, more rarely, a lesion to monitor. Treatment is not the same. The dermatologist examines the spot, with dermoscopy if needed, before prescribing anything.
The pregnancy mask often appears during the first months and sometimes fades after delivery. During pregnancy, care is limited to sun protection; depigmenting treatments and lasers wait until the end of pregnancy and breastfeeding. The dermatology and pregnancy page sets out the timeline.
It is a chronic pigmentation, prone to recurrence, especially under the Marrakech sun. The aim is to control it durably, not to promise it will disappear for good.
Yes. It is a pillar of treatment and of preventing recurrence, just like the products.
No. Hormones (pregnancy, contraception) often explain it, but the sun alone can trigger it, and men can have it too.
First you need to know which spots they are: melasma, sun lentigines and post-inflammatory marks do not have the same origin or treatment. The foundation is daily sun protection and prescribed depigmenting care; laser only comes in certain cases.
It depends on the type of spot, its depth and the skin type. On olive skin, the risk of pigment rebound calls for adapted settings and great caution; laser is a complement, never a replacement for sun protection and underlying treatment.
The first effects appear after several weeks of treatment and rigorous sun protection. Allow several months for clear lightening.
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