Melasma
Treatment options in Shanghai

Sunlight can worsen melasma and undermine an otherwise appropriate treatment plan. Broad-spectrum sunscreen, shade and a hat work together; sunscreen alone does not provide complete protection. Products containing iron oxides may add protection against visible light. The review should also consider relevant triggers, including pregnancy or hormonal medicines, without telling patients to stop necessary treatment independently. Explain your normal outdoor exposure and which products irritate your skin or are difficult to use. A plan that fits work and daily routines is more likely to be maintained than one relying only on an occasional procedure.

Topical approaches may include hydroquinone, a retinoid, combination preparations or other pigment-directed ingredients such as azelaic acid. They differ in suitability and irritation potential. More ingredients or a stronger concentration does not automatically produce a better result. Some preparations can cause irritation, excessive lightening or worsening pigmentation, so the clinician should specify duration, review points and what to do if problems appear. Pregnancy changes the discussion: hydroquinone and retinoid creams should be avoided in pregnancy according to British dermatology guidance. Tell the dermatologist about pregnancy plans and every product already used.

Laser and light procedures may be considered in selected patients, often alongside topical care and light protection. Results vary. Redness, pain and swelling may occur, and pigmentation can become darker or unevenly lighter; pigment-related adverse effects are particularly relevant in darker skin tones. Chemical peels and microneedling also have risks and are not automatically gentler substitutes. Ask which feature of your skin makes the proposed procedure reasonable and how its risks compare with continuing medical treatment. The decision should explain the expected additional benefit, rather than assume that a device is necessary because it is available.