- 501 Orchard Road, #04-08 Wheelock Place, Singapore 238880
- (65) 6235 4429
- hello@vidaskinclinic.com
- (65) 9830 0597
Melasma, patches of brownish or greyish pigmentation that typically appear on the cheeks, forehead, upper lip, or bridge of the nose, is one of the more stubborn and misunderstood pigmentation concerns women deal with, and hormonal fluctuation is a major driver of it. It’s well known in pregnancy, but a lot of women are caught off guard when new patches appear, or old ones darken, during perimenopause, when estrogen and progesterone are swinging rather than steadily declining.
“Melasma is one of the more frustrating things I treat, because it’s genuinely a chronic, hormonally-driven condition rather than something with a single fix,” says Dr Kay Low, senior aesthetic physician at VIDASKIN with a special interest in women’s skin health and hormonal skin changes. “Managing expectations properly from the start makes a real difference to how satisfied patients are with treatment.”
No treatment for melasma works reliably without strict, daily sun protection, and this includes visible light, not just UV, since visible light has also been shown to stimulate melanocyte activity in melasma-prone skin. Broad-spectrum sunscreen, ideally a tinted, iron-oxide-containing formula that also blocks visible light, along with physical sun avoidance measures like hats, is the foundation every other treatment is built on. Dr Kay Low tells patients plainly that skipping this step undermines everything else being done.
For patients who want a more decisive starting point than topicals alone, Cosmelan is one of the more established in-clinic options, and it’s often where Dr Kay Low starts with suitable melasma patients rather than building up to it gradually. It’s a two-phase professional depigmenting system built around azelaic acid, kojic acid, phytic acid, and vitamin C rather than hydroquinone, working across several points in the pigment-production pathway instead of blocking it at just one. The first phase is an in-clinic mask, left on for a period adjusted to skin type, generally shorter for lighter skin and longer for deeper skin tones, which matters particularly for medium-to-deeper skin, including many Asian skin types, where an overly aggressive approach risks triggering post-inflammatory pigmentation rather than resolving it. This is followed by months of a take-home maintenance cream and strict daily sun protection.
Expect some redness and tightness in the first few days, followed by visible peeling for around a week, and it’s common for existing pigment to look temporarily darker before it clears, which patients should be prepared for rather than alarmed by. It isn’t suitable during pregnancy or breastfeeding, or soon after isotretinoin use, and because inadequate sun protection afterward can trigger rebound pigmentation, this is a treatment for properly supervised, in-clinic use rather than something to attempt at home. “It’s one of the more effective tools we have for melasma, but it’s not automatically the right starting point for every patient,” says Dr Kay Low. “Skin type, how the melasma is presenting, and what someone’s already tried all factor into whether I recommend it first or build up to it.”
Topicals have a place both as a stand-alone approach for milder melasma and as the maintenance phase after a more intensive treatment like Cosmelan, and there’s no single one that does the job alone, which is part of why melasma has a reputation for being hard to treat. Hydroquinone is still one of the most effective depigmenting agents available on its own, inhibiting the enzyme melanocytes rely on to make pigment, but it’s a supervised, time-limited tool rather than something used indefinitely. Tranexamic acid, in topical form, takes a gentler route, calming the inflammatory signalling that sets melanocytes off in the first place, which is why it’s increasingly favoured for longer-term use.
Azelaic acid and niacinamide tend to play a supporting role: azelaic acid has mild depigmenting and anti-inflammatory properties and is considered safe even in pregnancy, while niacinamide interrupts the transfer of pigment to surrounding skin cells and helps the barrier at the same time. Retinoids round things out by speeding up cell turnover so existing pigment fades faster, though they raise sun sensitivity and need to be layered in carefully around sunscreen use. Dr Kay Low usually builds a regimen from two or three of these rather than reaching for all of them at once.
For more stubborn or widespread melasma, oral tranexamic acid is an option some patients are suited to, working through the same anti-inflammatory, anti-melanocyte-stimulating mechanism as the topical version, but systemically. It has a well-documented safety profile in appropriately screened patients, though it’s not suitable for everyone, in particular those with a personal or family history of blood clots, which is why Dr Kay Low only considers it after a proper medical history and, where relevant, discussion with a patient’s other treating doctors.
Melasma-prone skin isn’t just about excess pigment; it also tends to have a more reactive, less resilient barrier, and a weaker barrier makes skin easier to trigger by the heat, UV, and inflammation that set melanocytes off in the first place. This is where skin boosters can play a supporting role, not as a treatment for active pigmentation, but as a way of making the skin generally less reactive to what triggers it. Polynucleotide skin boosters, derived from purified DNA fragments, calm inflammatory signalling and oxidative stress in the skin while supporting its own repair processes; emerging research has specifically linked this anti-inflammatory action to reduced pigment-stimulating signalling following UV exposure, which is a plausible, if still developing, rationale for melasma-prone skin. Hyaluronic acid-based skin boosters take a more direct route, replenishing hydration within the skin to support barrier function and reduce the water loss that leaves reactive skin more vulnerable to its triggers.
Dr Kay Low positions these as a complementary layer rather than a primary melasma treatment, something to consider alongside sun protection, topicals or a Cosmelan course for patients whose skin is particularly reactive, rather than a replacement for treating the pigmentation itself directly.
Because melasma responds to a personalised combination of the treatments above, rather than any single ingredient or procedure, Dr Kay Low’s approach at VIDASKIN starts with a proper skin assessment to confirm the diagnosis, understand what’s likely triggering or worsening it, and work out whether Cosmelan, a topical-only regimen, oral treatment or supportive skin boosters, or some combination of these, actually fits that patient, rather than starting everyone on the same protocol.
Melasma is a chronic, relapsing condition rather than something that’s cured once and never returns. Most patients can achieve meaningful fading and much better control with consistent treatment and sun protection, but flares can still happen, particularly with sun exposure, hormonal changes, heat, or inflammation. “I’d rather set that expectation clearly upfront than have a patient feel like treatment failed when what’s actually happened is a normal flare,” says Dr Kay Low.
Hormonal changes, sun exposure and heat may contribute to melasma. A personalised medical assessment can help identify possible triggers and guide a suitable treatment plan.
At VIDASKIN, we focus on improving pigmentation while supporting long-term skin health and maintenance.
To learn more or book a consultation with Dr Kay Low, visit or contact us today.
Dr. Kay Low is a UK-trained medical doctor with over 7 years of clinical experience across the UK and Singapore, specialising in aesthetic medicine. A graduate of the University of Cambridge, she has worked across multiple medical and surgical disciplines in the UK and Singapore before completing postgraduate training in Family Medicine and advanced training in aesthetic medicine.
