Melasma: What It Is and How It Differs from ABNOM

What is Melasma?

You look in the mirror and the skin above your cheekbones seems clouded, as though a shadow were sitting on it, and after one summer it has darkened a little further — that is where the conversation about melasma usually begins. Clinically, melasma is a brown to grey-brown macule and patch with irregular borders, appearing symmetrically on sun-exposed areas of the face.

The distribution follows a few set patterns. The centrofacial pattern, covering the forehead, cheeks, nose and upper lip while sparing the philtrum, accounts for 50~80% of cases and is the most common; the malar pattern, concentrated on the cheeks and nose, and the mandibular pattern along the jawline follow. Extrafacial cases on exposed areas such as the arms or shoulders are also reported.

It occurs mainly in women, and the literature generally describes onset in the 20s to 40s. It is more common in darker skin (Fitzpatrick types III~IV, or III~V depending on the source), and a family member with the same condition is reported in about 60% of cases.

There is no single cause. Light exposure is the factor most consistently identified in both onset and recurrence, and short-wavelength visible light (blue light) has more recently been implicated in driving pigment in darker skin. Hormonal change — pregnancy, oral contraceptives, intrauterine devices and hormone replacement therapy containing estrogen and progesterone — as well as thyroid disease and phototoxic drugs or cosmetics are also associated. In occupations with repeated exposure to strong heat, such as cooking, baking, metalwork and glasswork, heat itself is described as making melasma chronic. The same literature notes, however, that no study has yet systematically examined the effect of solar infrared radiation on melasma.

Recent work views melasma not simply as melanocytes working too hard, but as a chronic inflammatory change in the microenvironment between the epidermis and the dermis. When the basement membrane is damaged, melanocytes and melanin granules drop into the dermis, and this is offered as the reason melasma persists and returns. Melasma is therefore less a matter of erasing something than of managing it over a long period.

The Other’s Root-Blocking Melasma Solution

What treatment does is not to burn pigment away, but to reduce the conditions that make pigment while gradually drawing down the melanin already deposited.

Low-fluence toning for melasma uses a 1064 nm Q-switched laser at low energy (roughly 3 J/cm² or less in the literature) over a wide spot, repeated at short intervals. The aim is not to destroy melanocytes but to break up only the melanosomes inside them. The reason for leaving the cells intact is plain — melasma-prone skin answers strong heat and inflammation by making more pigment.

So in melasma, turning the energy up does not translate into effect. Ablative lasers, which carry greater thermal injury, readily leave dyschromia, and low energy with short pulses is recommended instead; even at low energy, dyschromia is reported when intervals are too short. It is for the same reason that the literature places lasers after photoprotection and topical therapy have been settled first.

ABNOM, with pigment in the dermis, poses the opposite problem. Energy that disperses in the upper epidermis does not reach melanocytes in the papillary to mid dermis, so conditions that secure depth of penetration are required. This is why the same word — toning — cannot mean the same settings for the two lesions.

At The Other Dermatology, toning lasers of different character are combined — two or more within a single visit. Which devices are combined, and under what settings, depends on the depth and color of the lesion and on the condition of the skin, so it is decided at an in-person examination.

Aftercare

Sun protection is not care added on after a procedure; it is part of the treatment. Because light exposure is the factor most consistently identified in both the onset and the recurrence of melasma, the literature assumes year-round, long-term photoprotection regardless of season.

Evidence has accumulated that blocking ultraviolet alone is not enough. In a double-blind randomized trial in patients with melasma, the group using a product that blocks visible light as well as ultraviolet (containing iron oxide) saw greater pigment improvement from hydroquinone than the group using an ultraviolet-only product, and in a 2025 randomized, investigator-blinded study, worsening of pigment and color contrast across the summer was significantly reduced only with the tinted product. In a study of 39 French women, a broad-spectrum sunscreen containing iron oxide was reported to reduce recurrence after treatment. Experiments in healthy volunteers, in which visible light near 415 nm produced persistent pigmentation while 630 nm did not, are cited as the background to this difference.

That said, sunscreens are noted to fall short of their labeled performance in real use, because the amount applied and the frequency of reapplication are insufficient. Heat is managed alongside light — environments with repeated exposure to strong heat, such as cooking, baking, metalwork and glasswork, are named as factors that make melasma chronic. And because melasma-prone skin answers inflammation and heat by making pigment, rubbing the skin or adding harsh exfoliation after a procedure is also avoided.

Other conditions that look similar

Not every brown mark on the face is melasma. Freckles usually appear from the early teens as pale brown spots 1~3 mm across, scattered mainly over the cheeks and nose. Genetic predisposition weighs heavily and sunlight brings them out, so they characteristically darken in summer and fade in winter.

Solar lentigines (age spots) generally appear after the age of 40 on chronically photodamaged areas. Unlike freckles, they do not fade in seasons without ultraviolet stimulation but stay as they are, which is one point of separation; another is that they are discrete macules with relatively well-defined borders, unlike melasma, which runs together as though bleeding outward. The three form pigment in different ways, so they are approached differently, and when they are mixed on one face the visit begins by sorting out which is which.

Frequently asked questions

This page is general information about a treatment and is not a diagnosis or a recommendation. The right choice differs by skin condition, so treatment is decided after an in-person examination. Individual results vary.

References

1. Melasma StatPearls
2. Melasma DermNet NZ
3. Update on melasma — Part II: Treatment Dermatol Ther (Heidelb) 2022
4. Pathogenesis of melasma explained Int J Dermatol 2025
5. Acquired bilateral nevus of Ota-like macules: a case report NCBI PMC 2024
6. A comparative study of dermatoscopic features of melasma and Hori's nevus in Asian patients J Clin Aesthet Dermatol
7. The low-fluence Q-switched Nd:YAG laser treatment for melasma: a systematic review NCBI PMC
8. A retrospective study of 1064-nm Q-switched Nd:YAG laser therapy for acquired bilateral nevus of Ota-like macules NCBI PMC