My melasma keeps coming back. What am I doing wrong?
The short answer
Probably nothing. Melasma is a chronic pigment condition that tends to recur. Recurrence is the normal behaviour of the condition, not evidence that you or your clinic failed.
The goal is control over time rather than one aggressive clearance. And the single most common way melasma gets worse is treating it too hard, because heat and inflammation are themselves triggers.
Why it behaves differently from sun spots
A sun spot is a fixed deposit of pigment. Remove it and it is gone. Melasma is an ongoing process, pigment-producing cells that have become overactive and stay that way, influenced by hormones, UV exposure, visible light and heat. You are not clearing a stain. You are managing a system that keeps switching itself back on.
That is why the question is not which treatment removes it, but what keeps it quiet.
Why stronger settings backfire
Aggressive energy delivery creates inflammation, and inflammation drives pigment production. A treatment that looks impressive in the first fortnight can leave you darker three months later than when you started. Post-inflammatory hyperpigmentation on top of melasma is harder to manage than the melasma alone.
With most pigment, the risk is under-treating. With melasma, the risk is over-treating, and it is the more common mistake.
What a realistic plan looks like
- Daily protection first. Broad-spectrum SPF with iron oxide, which also screens visible light. This does more than any device, and without it nothing else holds.
- Topical management as the foundation, adjusted over time rather than run continuously at one strength.
- Conservative energy, where it is appropriate. Gentle settings at intervals, with the expectation of maintenance, not a course that ends.
- Heat awareness. Hot yoga, saunas, steam and long sun exposure all provoke it. Some patients find this matters as much as anything we do in clinic.
- Reassessment. If it is flaring against a stable routine, something external has usually changed: a new medication, a hormonal shift, a summer.
Where devices fit
Light and laser have a role, but a smaller and more careful one than in other pigment conditions. IPL and some laser settings can worsen melasma in the wrong hands or the wrong skin type. Where we use energy, we use it cautiously and we expect to repeat it, rather than chasing clearance in one session.
When active treatment can wait
Sometimes the right answer is to do less in clinic and more at home for a season. Sometimes it is to wait. Melasma that appeared during pregnancy or on a particular medication may settle on its own.
Medically reviewed by Seth Eberlin, MD, Medical Director at Essential Bella. Last reviewed 18 September 2026. General information, not a substitute for an in-person assessment.