Melasma is notorious for comebacks. These stubborn brown or greyish patches on the cheeks, forehead, upper lip, or jawline are a big cosmetic concern, for many women in India. Melasma, a chronic, relapsing condition, it often silently chips away the confidence and self-image. Despite advances in treatment and rising awareness, melasma has a frustrating habit of returning. To understand why, we must recognise how uniquely Indian skin responds to it.
A Typical Story from my Practice
Anita (name changed), a 38-year-old mother from Delhi, first visited me five years ago with cheek pigmentation that emerged during her second pregnancy. It improved with treatment, so she stopped follow-ups, applied sunscreen sporadically, and returned to her hectic life.
Two years later she was back, upset. The patches were darker, more extensive, and resistant to the same creams that had once helped. No new pregnancy had occurred. The culprits were subtler: daily commutes with sun exposure, inconsistent sunscreen use, work stress, and a short trial of over-the-counter “skin-brightening” creams. Anita’s experience is not unusual, it is the pattern I see repeatedly.
Why Indian Skin is Especially Prone
Most Indian women have Fitzpatrick skin types III to V. This means our skin produces melanin readily—a protective trait against sun damage, but one that turns problematic when pigment cells (melanocytes) become overstimulated.
Three key factors hit them particularly hard:
1. Hormonal triggers pregnancy, oral contraceptives, thyroid issues, perimenopause, and even minor hormonal fluctuations can activate melanocytes. Melasma often starts in pregnancy but can persist or reappear years later, even without an obvious hormonal cause.
2. Sun, heat, and visible light in India’s climate deliver intense year-round UV exposure. Many overlook that visible light (from sunlight or screens) and heat also aggravate melasma.
3. Genetic susceptibility and family history of melasma markedly raises the risk. In these cases, the skin is inherently “programmed” to overproduce pigment. Treatments can calm it, but they cannot eliminate the underlying tendency.
Melasma can be Managed, Not Cured
The single most important message for Indian women is this: melasma is not cured — it is controlled. Recurrence happens because:
Melanocytes retain memory. Even after visible fading, these cells stay hyper-reactive. One trigger—sunlight, irritation, or stress—can restart pigment production.
Inconsistent Photoprotection– Sunscreen is frequently treated like a temporary fix, applied only when pigmentation darkens.
Irritation fuels worsening harsh facials, frequent chemical peels, steroid-containing fairness creams, and aggressive home remedies inflame the skin.
At times, lasers, peels, and potent creams can dramatically improve appearance, but without ongoing care, benefits fade quickly.
A Realistic, Effective Long-Term Plan
1. Use broad-spectrum sunscreen (SPF 50+), reapply every 3–4 hours. Equally vital are physical barriers such as wide-brimmed hats, umbrellas, and scarves.
2. Topicals prescription creams with pigment inhibitors (hydroquinone, retinoids, azelaic acid, etc.) form the foundation but should be used cyclically and under guidance.
3. Focus on barrier repair, antioxidants (vitamin C, niacinamide), and strict avoidance of irritation. Peels or lasers help select patients but can worsen melasma in others.
4. Chronic stress, poor sleep, hormonal imbalances, and untreated thyroid issues undermine progress.
If approached with realism, respect, and consistency, Melasma can be managed effectively. The aim is not flawless skin, but lasting control, and restored confidence.