What is melasma, and why is it so common in Singapore?

Melasma is a chronic pigmentation condition that produces symmetrical brown or grey-brown patches on sun-exposed areas of the face. It is especially common in Singapore because Asian, melanin-rich skin reacts readily to triggers like sun exposure and hormonal change, yet is not dark enough to hide the patches once they form.

The pattern is well-documented locally. A retrospective study at a Singapore tertiary dermatological centre reported a mean patient age of 42.3 years and a female-to-male ratio of approximately 21 to 1, showing how strongly melasma affects women in this population. Research has also documented its meaningful impact on quality of life and confidence.

What causes melasma?

Melasma is driven by a combination of genetics, hormonal change, and sun exposure, with stress acting as an aggravating factor. Understanding the trigger matters, because melasma is managed by reducing these drivers, not just by removing the visible pigment.

• Genetics: a predisposition to react to triggers with increased pigment production.
• Hormonal change: surges during pregnancy, with oral contraceptives, or around menopause.
• Sun and light exposure: ultraviolet (UV) light darkens existing melasma and stimulates new pigment, and so does high-energy visible light (HEV), also called blue light.
• Stress and late nights: both are linked to flare-ups in clinical observation.

Why can aggressive laser treatment make melasma worse?

With melasma, more treatment is not better. Over-treating the skin, particularly with aggressive lasers, can trigger a protective response called rebound, in which the skin produces even more pigment than before. Dr Elias Tam explains:

The way that the skin protects itself is by producing more pigment, which is where you get rebound. And the rebound often is more severe than before.

This is why laser is not considered a first-line treatment for melasma. The National Skin Centre notes that melasma is best approached with a careful, combination strategy rather than a single device, and that inappropriate or aggressive settings can darken the skin further. A gradual, controlled plan matters more than a powerful machine.

How is melasma actually treated?

Melasma is best managed with a gradual, layered plan matched to a clinical assessment, not to a single device. The approach combines lifestyle and sun protection, topical agents, carefully sequenced lasers, and a pigmentation correction injectable.

Lifestyle and stress management

The first step is within the patient’s control: managing stress and reducing late nights, both of which are associated with melasma flare-ups.

Sun protection, done properly

Sun protection is the single most important controllable factor, and it is frequently misunderstood. Sunscreen has a half-life of roughly two hours, which means a single morning application may fall below effective protection by the early afternoon, even at a high SPF. Sunscreen needs to be applied in sufficient quantity and reapplied through the day, or a longer-acting formulation should be chosen.

Choosing the right sunscreen for melasma is more involved than picking the highest SPF, particularly because of HEV (blue light). We will cover this in detail in a separate article on sunscreen selection for melasma.

Topical agents that reduce pigment production

Prescription depigmenting creams and topical retinoids work by reducing the production of new pigment. They block tyrosinase, the key enzyme involved in melanin synthesis, so that pigment cleared by other treatments is not immediately replaced. Gentler options such as cysteamine and mandelic acid can also support pigment reduction.

Carefully sequenced lasers

Melasma typically sits at more than one depth, with both superficial and deeper pigment involved. Treatment targets the superficial layer first, followed by the deeper layer in stages. The process is deliberately gradual to avoid triggering the rebound described above.

A newer option: the pigmentation correction injectable

Until recently, there was no injectable specifically designed to address pigmentation. Dr Elias Tam describes the pigmentation correction injectable as a meaningful addition to the options available for melasma and post-inflammatory hyperpigmentation. It contains succinic acid, a compound previously used topically and now available in injectable form.

In Dr Elias’s clinical assessment, it works on more than one level: as an antioxidant that helps shift darker pigment (eumelanin) toward a lighter form (pheomelanin), and by binding copper at the active site of tyrosinase, making it less effective at producing new pigment. It is used as one modality within a wider treatment plan, matched to the individual’s clinical picture, rather than as a standalone treatment.

The Melanin Reset approach at EHA Clinic

At EHA Clinic, these treatment options sit within the Melanin Reset programme. Because pigmentation is not one thing, the combination used is matched to the type, depth, and cause of each patient’s pigmentation after a clinical assessment, rather than applying a fixed protocol to everyone.

How long does melasma treatment take?

Melasma improves gradually over months, not days, and typically requires several treatment sessions alongside ongoing maintenance. Because the underlying triggers, particularly sun exposure and hormonal influence, remain present, sun protection and topical maintenance continue even after the patches have lightened.

When should you see a doctor for melasma?

A clinical assessment is worth arranging if facial patches are spreading, are not responding to over-the-counter products, or are affecting your confidence. A doctor can confirm whether the pigmentation is melasma or another type, since the correct treatment depends on the cause and the depth of the pigment.

About Dr Elias Tam

Dr Elias Tam is the Medical Director of EHA Clinic. With over 20 years in aesthetic medicine, he serves as a Clinical Lecturer at University College London’s Master of Surgery in Aesthetic Medicine programme and is World President-Elect of the International College of Surgeons. He is the founder of the MyFace Cadaveric Workshop, which has trained doctors internationally since 2010.

To arrange a clinical assessment for pigmentation under the Melanin Reset programme, message EHA Clinic on WhatsApp at 8168 7235.

Frequently asked questions

Can melasma be permanently cured?

Melasma is a chronic condition and is managed rather than permanently cured. With consistent sun protection, topical maintenance, and an assessment-led treatment plan, it can be controlled and kept lighter over time.

Why does my melasma keep coming back?

Melasma is driven by sun exposure, hormones, and genetics, and these triggers do not disappear after treatment. Without ongoing sun protection and maintenance, pigment production can resume, which is why melasma often returns.

Does blue light cause melasma?

High-energy visible light (HEV), often called blue light, can aggravate melasma. Blue light comes from sunlight as well as from devices such as phones, laptops and screens. Standard SPF sunscreens do not always block HEV, so sun and light protection for melasma involves more than choosing a high SPF. We will cover this in more detail in a separate article on sunscreen selection for melasma.

Is laser the best treatment for melasma?

Laser is not a first-line treatment for melasma. Used aggressively, it can trigger rebound and darken the skin further. When it is used, it is one part of a gradual, carefully sequenced plan rather than the starting point.

What is the pigmentation correction injectable?

It is a newer injectable modality containing succinic acid. Dr Elias Tam describes it as working as an antioxidant and by reducing the activity of tyrosinase, the enzyme involved in pigment production. It is used as one component of a wider treatment plan, matched to a clinical assessment.

How do I start treatment for melasma?

The right starting point is a clinical assessment, so the cause and depth of your pigmentation can be identified and a suitable combination chosen. You can arrange this through EHA Clinic on WhatsApp.

Disclaimer

This article is for general education and does not replace a personal medical consultation. Treatments are carried out only after a clinical assessment, and suitability and response vary between individuals. Please consult a doctor about your specific condition.

References

National Skin Centre, Singapore. Melasma. nsc.com.sg

Retrospective study of melasma at a Singapore tertiary dermatological referral centre. pubmed.ncbi.nlm.nih.gov/10560271

The effect of melasma on quality of life in a sample of women living in Singapore. pmc.ncbi.nlm.nih.gov/articles/PMC4756868