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Pigmentation Condition · Kensington, London
Melasma Treatment in London, Matched to Your Skin Tone and the Depth of the Pigment
Melasma is a chronic pigmentation condition that produces symmetrical brown or grey-brown patches across the cheeks, forehead, upper lip and jawline. Hormones, ultraviolet light and heat drive it together, and it recurs readily once cleared. At Faciem in Kensington, Dr Prasad confirms the diagnosis and how deep the pigment sits before any treatment begins.
- Diagnosis and pigment depth checked first
- Experienced in deeper skin tones
- Kensington Church St, London
- Medically reviewed by Dr Prasad
This page sets out how melasma is diagnosed, treated and maintained at Faciem, and is reviewed for clinical accuracy.
Last reviewed: 15 September 2026.
Patient information only. Melasma varies considerably in depth and behaviour, and any treatment plan follows a face-to-face consultation with Dr Prasad.
Patients since 2019
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TL;DR
Melasma is a chronic pigmentation condition producing symmetrical brown patches on sun-exposed areas of the face, driven by hormones, ultraviolet light and heat acting together. It is far more common in women, particularly during pregnancy or on hormonal contraception, and in deeper skin tones. Treatment suppresses pigment production with prescription-strength skincare, lifts the pigment already present with carefully chosen peels, and protects the result with daily sun protection: most people notice a change within a few weeks, and a course usually runs three to four months. Melasma is controlled, not cured, so maintenance continues afterwards. Assessment at Faciem Dermatology & Medical Clinic is by Dr Prasad, a GMC-registered doctor with 20 years’ experience.
- Symmetrical patches on cheeks, forehead and upper lip
- Hormones, ultraviolet light and heat together
- Controlled, not cured — it recurs without maintenance
About the Condition
What Is Melasma?
Melasma is a chronic disorder of pigmentation in which melanocytes overproduce melanin in a characteristic symmetrical pattern across sun-exposed areas of the face. Unlike sun spots, which are discrete and sharply defined, melasma forms broad patches with irregular but roughly mirrored borders, and its activity fluctuates with hormones, sunlight and heat.
What melasma looks like, and why depth matters
Melasma appears as flat patches of light to deep brown, sometimes grey-brown, with borders that are irregular yet broadly symmetrical between the two sides of the face. Three distributions are typical: centrofacial, covering the forehead, nose, upper lip and chin; malar, across the cheeks; and mandibular, along the jawline. The upper lip pattern is often mistaken for a shadow or a moustache and is one of the more distressing presentations. Depth then decides how melasma behaves. Epidermal melasma sits superficially, looks brown and well defined, and responds relatively well. Dermal melasma sits deeper, looks greyer and less distinct, and is considerably more stubborn. Many people have a mixture of the two, which is why the skin is examined in person under magnification and not judged from a photograph.
Who tends to get melasma
Melasma affects women far more often than men, and most commonly appears between the twenties and forties. Pregnancy is a frequent trigger, which is where the older name chloasma, or the mask of pregnancy, comes from; hormonal contraception and hormone replacement therapy can produce the same effect. Melasma is markedly more common in people with deeper skin tones, particularly South Asian, East Asian, Hispanic, Middle Eastern and Black skin, and in those with a family history of it. Sun exposure is the constant across all groups. Melasma can settle after pregnancy ends or contraception is changed, but frequently it does not, and it tends to return each summer without protection. Skin tone is graded on the Fitzpatrick scale, from I (always burns, never tans) to VI (deeply pigmented, rarely burns), and that grading shapes the whole plan. Melasma is most common in Fitzpatrick III to V skin, and those same skin types make more pigment in response to irritation, so peel strength is kept lower, intervals longer, laser is approached with caution, and a test area is used first. The risk being managed in Fitzpatrick IV to VI skin is post-inflammatory hyperpigmentation — new pigment created by the treatment itself — which is why melasma there is treated slowly and from the pigment cells outwards, not resurfaced first.
What melasma is often confused with
Melasma is regularly mistaken for other pigmentation, and the distinction changes the treatment. Sun spots and freckles are discrete, sharply edged and often respond to targeted treatment that would aggravate melasma. Hyperpigmentation that follows inflammation traces the outline of whatever caused it, such as a spot or a scratch, and usually fades with time. Poikiloderma of Civatte produces red-brown discolouration on the sides of the neck, sparing the shaded area under the chin. Drug-induced pigmentation and lupus-related rashes can also mimic melasma. Because several of these respond to approaches that make melasma darker, accurate diagnosis matters more here than in almost any other pigmentation problem.
Causes & Contributing Factors
What Causes Melasma?
Melasma is caused by melanocytes becoming overactive under the combined influence of hormones, ultraviolet light and heat. No single one of these explains it; they act together, which is why melasma flares in summer and during pregnancy and settles only partially when one trigger is removed.
Hormonal change
Oestrogen and progesterone stimulate melanocyte activity, which is why melasma commonly begins during pregnancy or after starting hormonal contraception or hormone replacement therapy. The pigmentation may persist long after the hormonal trigger has gone.
Ultraviolet light
Ultraviolet exposure activates already-sensitised melanocytes and is the most reliable trigger for a melasma flare. Short incidental exposure counts too, through a window or on a cloudy day, which is why daily protection matters year round.
Visible light and heat
Melasma responds to visible light and to heat as well as to ultraviolet, which sets it apart from most other pigmentation. Cooking over a hot stove, saunas and hot yoga can all aggravate it independently of sun exposure.
Genetics and skin tone
A family history of melasma is common, and melasma occurs far more frequently in deeper skin tones. Neither can be changed, so management concentrates on the triggers that can be.
Irritation from earlier treatment
Melasma can be worsened by treatment that is too aggressive, because inflammation stimulates the same pigment cells. Peels and laser settings that suit sun spots may leave melasma darker if the pigment cells have not been calmed first.
Treatments We Offer
How Is Melasma Treated at Faciem?
Melasma treatment at Faciem works in three directions at once: suppressing melanin production, lifting the pigment already in the skin, and controlling the triggers that reactivate it. Sequence is part of the treatment. Prescription-strength skincare comes before anything that resurfaces the skin, because resurfacing unprepared melasma can leave it darker than it started.
01
Medical-Grade Skincare
Prescription-strength actives suppress melanin production and remain the mainstay of melasma treatment. Both hydroquinone and non-hydroquinone approaches are used, chosen for your skin tone, and the maintenance regime afterwards is what keeps melasma from returning.
Best for: all melasma, and long-term maintenance
Read about Medical-Grade Skincare
02
TCA Peel
Trichloroacetic acid peels — the ZO 3 Step Peel or Controlled Depth Peel — lift pigment across broader patches once prescription skincare has calmed the pigment cells. That preparation is not optional in melasma, and peel depth is chosen for your skin tone.
Best for: larger patches, after skin preparation
Read about TCA Peel
03
Chemical Peels
Lighter peels lift superficial pigment and even out overall tone alongside daily treatment. Strength stays deliberately conservative in melasma, because irritation is itself one of its triggers.
Best for: superficial pigment and maintenance
Read about Chemical Peels
Laser resurfacing is used cautiously in melasma, and only alongside treatment that controls the pigment-producing cells, because heat and inflammation can reactivate them; a combined approach is safer than laser alone. Which treatments are used, in what order and for how long is decided by Dr Prasad after examining your skin, and outcomes differ from person to person.
When to Seek Medical Advice
When Should You See a Doctor About Melasma?
See a doctor about melasma before you start treating it, not after several products have failed, because melasma can be aggravated by approaches that suit other pigmentation. Assessment establishes whether it is melasma at all, how deep the pigment sits, and what can be used safely on your skin tone.
Worth getting checked
- Symmetrical brown or grey-brown patches across the cheeks, forehead or upper lip
- Pigmentation that darkens every summer and only partly fades over winter
- Pigmentation that appeared during pregnancy, or after starting the pill or HRT
- Patches that darkened after a peel, a laser session or a strong over-the-counter product
Conditions that can look similar
- Sun spots, post-inflammatory hyperpigmentation, poikiloderma of Civatte and drug-induced pigmentation can all resemble melasma, and several respond to treatment that would aggravate it. Pigmentation that is asymmetrical, raised, or confined to one patch that is changing needs examination, not assumption. Anything that itches, bleeds or grows should be seen in person.
Self-Care & Prevention
How Do You Manage Melasma Between Appointments?
Sun protection is not an adjunct to melasma treatment; it is the treatment everything else depends on. Because melasma reacts to visible light and heat as well as to ultraviolet, a tinted mineral sunscreen and a habit of seeking shade do more than a higher SPF number alone.
Do
- Wear broad-spectrum SPF 50 every morning, year round, and reapply every two hours outdoors
- Use about half a teaspoon of a tinted mineral sunscreen on the face, which also screens visible light
- Wear a wide-brimmed hat and seek shade between 11am and 3pm, when ultraviolet is strongest
- Keep maintenance treatment going for at least six months after the patches clear, because melasma returns without it
Avoid
- Sunbeds and deliberate tanning of any kind, in all twelve months of the year
- Saunas, steam rooms and hot yoga for the three to four months of a course, because heat alone darkens melasma
- Harsh scrubs and strong acids used without advice, and any new active that still stings after 48 hours
- Unregulated skin-lightening creams bought online, some of which contain mercury or potent steroids banned in UK cosmetics
This is general guidance and does not replace individual assessment. What suits your skin depends on the depth of your melasma and on your skin tone.
Why Patients Choose Faciem
Why Choose Faciem for Melasma Treatment?
Melasma punishes over-treatment. The approaches that clear sun spots quickly can leave melasma darker than it started, and much of the difficulty patients arrive with was caused by earlier treatment, not by the condition itself. Faciem treats melasma slowly and in the right order for that reason.
- Diagnosis confirmed and pigment depth judged before anything resurfacing is considered
- Skin examined in person by Dr Prasad, a GMC-registered doctor with 20 years’ experience
- Deliberately conservative in deeper skin tones, where irritation itself creates pigment
- Maintenance planned from the first appointment, because melasma recurs without it
Experience & Expertise
Why Does Melasma Need a Doctor’s Judgement?
Melasma is the pigmentation condition most often made worse by its own treatment. It is driven partly by inflammation, so a peel or a laser setting that would clear a sun spot can stimulate the pigment cells it was meant to suppress — and that risk is highest in exactly the skin tones melasma most often affects. Depth compounds the problem: epidermal melasma responds far better than dermal melasma, and the difference is not obvious to the naked eye. Dr Prasad takes a full history, examines the skin under magnification, and establishes whether it is melasma, how deep the pigment sits, what can be used safely on your skin tone and what maintenance will be needed, because clearing melasma is the easier half of the problem.
- Dr Anamica Prasad — MBChB (1999), Dip Dermatology (2001), MRCGP, DFFP, DRCOG · a GMC-registered doctor
- Member of the Joint Council for Cosmetic Practitioners (JCCP), British Medical Laser Association (BMLA), Royal Society of Medicine and the Aesthetic Complications Group
- Clinic operated by Derma Medical UK Ltd, registered with the Care Quality Commission for diagnostic and screening procedures, surgical procedures, and treatment of disease, disorder or injury · CQC Location ID 1-25573003746
- Face-to-face consultation with the skin examined under magnification before a melasma plan is made
- 20 years’ experience in dermatology, with a particular interest in pigmentation across every skin tone
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Melasma FAQs
Your Questions, Answered
Melasma raises the same handful of questions in almost every consultation: how long treatment takes, whether the patches come back, and what is safe to use on deeper skin tones. If yours is not answered below, bring it to your appointment.
What causes melasma?
Melasma is caused by pigment cells becoming overactive under three influences acting together: hormones, ultraviolet light and heat. Pregnancy, the contraceptive pill and hormone replacement therapy are common starting points, sunlight reliably darkens established patches, and genetics and skin tone decide who is susceptible in the first place. No single factor explains melasma, which is why treatment has to address all of them.
Does melasma go away on its own?
Melasma that began in pregnancy sometimes fades over the months after birth, and it may settle if hormonal contraception is changed. More often it persists, and it typically darkens each summer. Because melasma is chronic and recurring, it is usually managed continuously, with daily sun protection and maintenance treatment, instead of being waited out.
How long does melasma treatment take to work?
Most people notice a difference within a few weeks of starting treatment for melasma, and a course usually runs three to four months before moving on to maintenance. Deeper dermal pigment takes longer and improves less completely than superficial epidermal pigment. Progress is reviewed as you go, and daily sun protection throughout is what protects the result.
Can melasma be treated while pregnant or breastfeeding?
Melasma can be managed during pregnancy and breastfeeding, but the options narrow. Hydroquinone, retinoids and most peels are set aside until afterwards, so treatment concentrates on daily SPF 50, a tinted mineral sunscreen and pregnancy-appropriate actives such as azelaic acid. Melasma that began in pregnancy often lightens in the six to twelve months after birth, so active treatment is usually planned for after that, once breastfeeding has finished. Tell Dr Prasad at the consultation if you are pregnant, trying to conceive or breastfeeding.
Can I wear makeup while being treated for melasma?
Yes — makeup can be worn throughout melasma treatment, and mineral foundation over a tinted sunscreen adds useful protection from visible light. The one pause is after a peel: leave the skin bare for 24 hours, then use only gentle mineral makeup while it flakes, usually days three to seven. Remove it with a non-foaming cleanser, and skip anything that has to be rubbed off.
Can laser remove melasma?
Laser is used cautiously in melasma, and only alongside treatment that suppresses pigment production, because the heat and inflammation a laser creates can reactivate the same pigment cells. Used on its own it can leave melasma darker than it started, particularly in deeper skin tones. Prescription-strength skincare first, then a combined approach, is the safer sequence.
What determines the cost of melasma treatment?
The cost of melasma treatment depends on how deep and how widespread the pigment is, whether prescription-strength skincare alone is enough or a peel is added, and how long the course and the maintenance that follows run. Peel prices are published on our chemical peels page. Your full plan is priced and confirmed in writing before treatment begins.
Sources & Further Reading
- Melasma patient information leaflet — British Association of Dermatologists
- Melasma — DermNet NZ
- Disorders of skin pigmentation — DermNet NZ
These are general sources of patient information and do not replace individual medical assessment. Your own diagnosis and treatment plan are established at consultation.
Melasma in Kensington, London
A Doctor-Led Clinic in the Heart of Kensington
Melasma assessment and treatment are available at Faciem Dermatology & Medical Clinic on Kensington Church St, London, led by Dr Prasad. Melasma is managed as a course over three to four months, with reviews along the way and maintenance afterwards, so the practicalities count: the clinic is a few minutes’ walk from High Street Kensington station and about ten from Notting Hill Gate, and it stays open until 7pm and on Saturdays, which keeps follow-up appointments from eating into a working week.
Plan Your Visit
- Faciem Dermatology & Medical Clinic
- Phone: +44 20 7131 3539
- 7 Kensington Church St, London W8 4LF, United Kingdom
- Tube: High Street Kensington (few minutes’ walk) · Notting Hill Gate (~10 minutes)
- Parking: Kensington council underground car park nearby
- Open Monday–Saturday, 10am–7pm · Sunday closed
- Melasma consultations bookable online; treatment planned once the skin has been examined
- Consultation-first — no treatment without medical assessment
- Serving Kensington, Chelsea, Notting Hill & Central London
Continue Exploring
Related Conditions & Treatments
Hyper-pigmentation
The umbrella condition melasma belongs to, covering sun damage, post-inflammatory marks and how each type is told apart.
Read more →
Brown Spots & Freckles
Sun-related spots are discrete and sharply edged, and they respond to targeted treatment that can aggravate melasma.
Read more →
Neck & Chest Ageing
Mottled sun damage below the jawline, where thinner skin is treated more gently than the face.
Read more →
Faciem Dermatology & Medical Clinic · Kensington
Have Your Melasma Diagnosed Before You Treat It
Book a consultation with Dr Prasad to confirm that it is melasma, judge how deep the pigment sits, and agree a plan that suits your skin tone. Appointments in Kensington, Monday to Saturday.
Prefer to talk? +44 20 7131 3539