What is melasma?
Melasma (also called chloasma or 'the mask of pregnancy') is a chronic pigmentation condition characterised by symmetrical brown, tan, or greyish patches on sun-exposed areas of the face — most commonly the cheeks, forehead, bridge of the nose, and upper lip. Unlike ordinary dark spots, melasma patches are large, diffuse, and bilateral (appearing on both sides of the face).
It is significantly more prevalent in women (affecting approximately 90% of cases), particularly those of Fitzpatrick Type III–V (olive to dark skin) — the predominant skin tones in South Africa's KwaZulu-Natal region. This combination of hormonal drivers and South Africa's intense year-round UV environment makes melasma both common and particularly difficult to treat.
What causes and triggers melasma
The primary driver of melasma is hormonal — oestrogen and progesterone stimulate melanocytes (melanin-producing cells) to overproduce pigment. This is why melasma commonly appears or worsens during pregnancy, when taking oral contraceptives, or during hormonal therapy. Stopping the hormonal trigger sometimes leads to spontaneous improvement, but often the pigmentation persists.
UV radiation is the most critical aggravating factor. Melasma is dramatically worsened by even brief sun exposure without protection — and crucially, visible light (wavelengths 380–700nm) can trigger melanin production in darker skin tones independently of UVA and UVB. This means standard chemical-only sunscreens may be insufficient; Heliocare 360° Pigment Solution, which contains Fernblock® and filters for visible light, is the recommended SPF for melasma patients.
Treating melasma — what actually works
Melasma cannot be permanently cured — it can be suppressed and managed. No single product eliminates it. An effective protocol combines: mandatory daily SPF 50+ with visible light protection (Heliocare 360° Pigment Solution), a tyrosinase inhibitor to suppress melanin production (azelaic acid, kojic acid, tranexamic acid, or niacinamide), and a depigmentation agent for existing pigment (vitamin C serum, glycolic acid).
For moderate to severe melasma, the Cosmelan depigmentation peel is the most effective clinical treatment available. An in-clinic application is followed by a home maintenance protocol using Cosmelan 2 maintenance cream. Clinical studies show significant reduction in melasma severity in the majority of patients within 3–6 months. At Star Aesthetic Centre, the Cosmelan protocol is a signature treatment for melasma.
Managing melasma long-term
Melasma is a chronic condition — it can return after successful treatment if sun protection lapses or hormonal triggers resume. Long-term management requires continuous daily SPF 50+ (even on cloudy days), ongoing use of maintenance depigmenting products, and sun-avoidance habits such as wide-brimmed hats and seeking shade during peak UV hours (10am–3pm in KwaZulu-Natal).
Treatment in summer in South Africa requires extra diligence — UV is intense year-round in Durban, but peaks between October and March. Patients starting Cosmelan protocol are counselled on realistic expectations: significant improvement is achievable, but sustained results require a lifelong commitment to sun protection.