Histopathologically, melasma is divided into three main forms according to the localisation of the pigment deposit:

• Epidermal melasma: The pigment deposit is located in the uppermost layer of the skin (epidermis), the patches are sharply defined and brown in colour. This form is usually easy to treat.
• Dermal melasma: The pigments are located in the deeper layer of the skin (dermis), the spots appear grey or bluish and are less sharply defined. This form is more difficult to treat.
• Mixed type: Combination of both forms; both superficial and deeper pigments are affected, which makes treatment more difficult.

The cause is an overproduction of melanin, which can be triggered or intensified by hormonal changes, UV radiation or genetic predisposition, among other things. Women with a darker skin type are particularly frequently affected. The pigmentation change is medically harmless, but can affect aesthetic perception and self-confidence.

The treatment of melasma is complex, requires patience and usually consists of a combination of different forms of therapy. The aim is to inhibit melanin production and gently break down existing pigments. The most important pillars of therapy are

• Consistent sun protection (SPF 50+): daily, all year round, even on cloudy days
• Avoidance of direct UV radiation
• Topical active ingredients: Creams with lightening ingredients such as vitamin C, azelaic acid, hydroquinone (only under medical supervision), kojic acid or tretinoin can reduce pigmentation
• Laser therapy: Modern laser treatments aim to remove excess melanin in a targeted manner. They are an option for deeper or therapy-resistant melasma in particular, but should be used with caution on darker skin types.

The combination of different therapeutic approaches generally leads to better results than individual treatments.

According to current research results and clinical experience, the following types of laser are considered particularly effective in the treatment of melasma: Nd:YAG 1064nm laser toning, fractionated non-ablative lasers. The latter can not only support skin regeneration, but also improve the absorption of lightening agents.

The number of laser sessions required varies depending on the individual severity of the melasma and the type of laser used. Depending on the severity, between 5 and 15 treatment sessions are necessary.

• The success of the treatment is usually slow; patience is important.
• Complete disappearance of the spots cannot be guaranteed, but a significant visual improvement is possible.
• In the case of hormonal causes (e.g. pill, hormone replacement therapy), it should be checked with the doctor whether a change of medication is advisable.
• After successful therapy, consistent prevention* is crucial to avoid relapses.

* Daily sun protection factor 50+ - even on cloudy days

The skin "remembers": once overactive, melanocytes can be reactivated at any time by UV radiation or hormones. Long-term aftercare is therefore crucial.