Melasma Treatment In London

Medically Reviewed by Doctor Björn Thomas, GMC: 7084005

Melasma is a common, benign condition resulting in pigmentation that usually appears as symmetrical brown or grey-brown patches on sun-exposed areas of the face. It is not contagious, is not caused by poor hygiene, and, the reassuring factor: it does not turn into skin cancer. It is more common in women, particularly during pregnancy, and it is also seen more often in people who tan easily or have a darker skin tone. 

Although melasma is medically harmless, we know from patient experience and clinical practice that it can have a very real effect on confidence and day-to-day comfort. Many people feel frustrated by persistent pigmentation, especially when it flares again after sun exposure or when over-the-counter products have done very little. 

With this in mind, the aim of a dermatology consultation is not to overpromise, but to give you an accurate diagnosis, a realistic plan, and clear advice on how to manage the condition well over time.

What Is Melasma?

Melasma develops when pigment-producing cells in the skin produce too much melanin. In practice, it is usually triggered by a combination of factors rather than one single cause. The most commonly associated trigger is ultraviolet light,  changes in hormones (i.e., during pregnancy,  or with hormonal contraception/replacement), family tendencies, irritation from certain cosmetics or procedures and some medicines can all contribute. Melasma often becomes more noticeable in summer and can ease in winter.

It most often affects the cheeks, forehead, nose, upper lip and chin. Less commonly, it can appear on the neck, chest or forearms. The patches are flat rather than raised, and they are usually not itchy or painful.

Book a Private Consultation for Melasma Treatment in London

A consultation is the first step, because melasma needs to be distinguished from other causes of facial pigmentation before treatment is planned. 

During your appointment, we usually ask about sun exposure, pregnancy history, hormone use, medications, previous skincare, family history and whether the pigmentation changes with the seasons. We would then examine the skin carefully and, where helpful, use tools such as dermoscopy or a Wood’s lamp to assess the depth and pattern of pigment. Biopsy is only rarely needed.

You can self-refer directly for a private consultation. That gives you time to talk through what has and has not worked before, understand the likely triggers in your case, and leave with a treatment plan that feels tailored rather than generic.

Common Symptoms of Melasma

Melasma usually shows as blotchy, symmetrical patches of darker pigment. Depending on skin tone and pigment depth, the colour may look light brown, dark brown or blue-grey. 

The most common facial patterns are:

• Centrofacial: forehead, cheeks, nose and upper lip.
• Malar: cheeks and nose.
• Mandibular: jawline.

Melasma is often recognisable on examination, but other causes of facial hyperpigmentation do need to be considered; for example, other causes should be sought if the pigmentation is new, unusual, one-sided, changing quickly or does not look typical.

Areas on the Body That Melasma Can Develop

The face is by far the most common site. However, extra-facial melasma can occasionally develop on the neck, chest and forearms, especially in sun-exposed areas. Sunlight remains a major aggravating factor, which is why year-round protection is such an important part of treatment and maintenance.

Melasma Treatments in London by the Thomas Clinic

Melasma treatment works best when it is approached as long-term management rather than a quick fix. The goal is usually to reduce visible pigmentation, control flare-ups, and maintain improvement with the right combination of prescription treatment, skincare and photoprotection. That matters because recurrence is common, even after a good response.

Topical Treatments

Topical treatment is often the starting point. One of the main prescription options is a combination approach using hydroquinone, a retinoid and a mild topical steroid, because these ingredients work together to reduce pigment production, improve cell turnover and limit irritation. Other options that may be appropriate include azelaic acid, vitamin C, kojic acid, cysteamine and thiamidol.

Not every product suits every patient. Some treatments are better used for short courses, some are better for maintenance of the condition, and some should be avoided during pregnancy. In particular, hydroquinone and retinoid creams should not be used during pregnancy.

Whatever topical treatment is chosen, sun protection is essential. Without that, even good prescription treatment is far less likely to hold its results. BAD guidance highlights SPF 30 or above, while NHS guidance advises at least SPF 30 with at least 4-star UVA protection. BAD and PCDS guidance also note that visible light can worsen melasma, which is why tinted or mineral sunscreens are often helpful.

Oral treatments

In selected cases, tranexamic acid may also be discussed. Oral tranexamic has been shown to be an effective treatment for more stubborn cases. It is considered a safe treatment for the condition. It must be noted that there have been very rare cases of blood clots seen whilst on treatment, therefore we recommend a careful history and also blood tests for Protein C and S levels (we are aware that some practitioners do not routinely check these).

Medical Procedures

Chemical peels, microneedling and some laser treatments are sometimes used as part of melasma management, particularly in carefully selected cases. However, these treatments need to be approached cautiously because they can also worsen pigmentation if not chosen well or performed by an inexperienced practitioner. Chemical peels and microneedling are not currently performed at the Thomas Clinic.

For that reason, we would only discuss procedural treatment once the diagnosis is clear, the skin has been prepared properly, and the likely benefits and risks have been weighed up carefully. These procedures are not currently offered as part of this melasma treatment, but they are worth understanding because many patients ask about them.

What to Expect from Melasma Treatment

Your first appointment should give you clarity. That usually means discussing triggers, examining the pigmentation pattern, deciding whether the features are typical of melasma, and then agreeing on a practical treatment strategy. In many cases, treatment begins with prescription topical therapy and strict sun protection, with follow-up used to review response and tolerance. 

Long-term improvement usually depends on consistency rather than intensity. Gentle skincare, avoiding obvious irritants, daily photoprotection, and realistic expectations all matter. Even when the pigmentation improves very well, maintenance is often needed because melasma can recur.

Register with the Clinic to Begin Your Skin Treatment Journey

If you would like advice on persistent facial pigmentation, you can book directly without the need for a GP referral. Private consultation allows you to discuss diagnosis, triggers, treatment choices and likely outcomes more individually, with enough time to ask the questions that matter to you. 

Register for Treatment

Consult the Thomas Clinic About Melasma or Suspected Melasma

Melasma may be harmless in medical terms, but that does not mean it feels minor when you are living with it. 

If it is affecting your confidence, your work life, or simply how comfortable you feel without make-up, it is reasonable to want proper advice. We recognise the emotional impact melasma can have, and that is one reason a careful, supportive consultation matters.

What to Expect from Melasma Treatment at the Thomas Clinic

At the Thomas Clinic, we treat melasma with a structured, personalised approach that prioritises your comfort, emotional well-being, and long-term results. Here’s exactly what to expect during your consultation and treatment journey:

Your Step-by-Step Melasma Treatment Journey:

Step 1: Comprehensive Initial Consultation
In your private, empathetic initial meeting, Dr Thomas will carefully discuss your skin concerns, covering:

• Sun exposure habits
• Hormonal history (pregnancy, contraceptive pills, hormone replacement therapy)
• Medications and cosmetics
• Family history of melasma
• Timing and seasonal variation of pigmentation
• Emotional and social impacts

Step 2: Thorough Examination and Diagnosis
Dr Thomas conducts a precise visual assessment, evaluating pigment symmetry, pattern, and depth using advanced tools:

• Wood’s Lamp Examination to determine pigmentation depth and guide treatment choices.
• Dermoscopy to confirm detailed pigment and vascular characteristics.
• Differential Diagnosis to accurately distinguish melasma from other conditions.

Step 3: Personalised Treatment Planning
Following diagnosis, Dr Thomas creates a tailored treatment strategy, typically starting with topical therapies or oral medications. Skin preparation using topical creams typically precedes any advanced cosmetic procedures, enhancing safety and results.

Step 4: Cosmetic Procedures (Not currently offered at the Thomas Clinic)
When melasma persists despite initial treatments, though not commonly used, certain cosmetic interventions can be considered:

• Chemical Peels: Gentle, superficial peels exfoliate pigment and brighten skin.
• Laser Therapy: Precise, low-fluence lasers selectively reduce deeper pigmentation.
• Microneedling: Enhances penetration and effectiveness of topical treatments.

All procedures are carefully selected and expertly performed to maximise effectiveness and minimise risk.

Professional Aftercare and Long-term Management:

Melasma is chronic, requiring careful ongoing maintenance. Our clinic provides structured aftercare guidance, including:

• Rigorous Photoprotection: Daily, year-round use of high-quality, tinted SPF 50+ sunscreen and protective habits (shade, hats, sunglasses).
• Maintenance Strategy: Transitioning from intensive initial treatments to gentle, sustainable topical therapies, with regular follow-ups.
• Gentle Skincare Regimen: Avoiding harsh skincare products and using fragrance-free cleansers and non-comedogenic moisturisers to protect skin health.
• Cosmetic Camouflage Advice: Guidance on effectively using foundations and concealers to boost confidence during treatment.
• Realistic Expectations and Emotional Support: Clear communication about gradual improvement, ongoing management, and emotional reassurance, emphasising melasma’s benign nature.

At the Thomas Clinic, we empower you with expert guidance, continuous emotional support, and personalised care, helping you confidently manage melasma for the long term.

Register with the Clinic to Begin Your Skin Treatment Journey

Starting your personalised melasma treatment at the Thomas Clinic is straightforward, discreet, and convenient. You can book your private consultation directly—no GP referral needed—via our easy online booking system, by email, or by calling our clinic directly by phone.

Private dermatological care ensures timely access to specialist expertise, personalised guidance, and reassurance throughout your treatment. At our Harley Street clinic, your comfort, discretion, and confidence are prioritised, creating a supportive environment tailored specifically to your needs. Our team is ready to help you restore skin clarity and emotional well-being—reach out today to arrange your confidential consultation.

Speak to Our Skin Specialists

Although melasma is medically harmless, its visible presence can deeply affect your confidence, emotional well-being, and daily comfort. Feeling self-conscious or quietly distressed by pigmentation is entirely understandable, and seeking expert guidance is a positive first step. At the Thomas Clinic, we provide discreet, personalised, and empathetic care, ensuring you fully understand your condition and confidently explore your treatment options.

Patients who successfully treat melasma frequently experience significant emotional improvements—renewed self-esteem, reduced anxiety, and greater comfort in social and professional situations. Our specialists are here not only to address the pigmentation itself but also its emotional effects. If melasma impacts how you feel about yourself, you’re not alone. We’re here to help you regain your skin clarity, confidence, and emotional well-being.