Understanding Why Melasma is Difficult to Treat
Melasma shows up when several different factors team up to over‑produce pigment in your skin. Even a little sun can "wake up" melanocytes (the cells that make colour), while hormone shifts—like those during pregnancy or from birth control—can push them into overdrive.
Treating melasma is never a one-and-done affair—its stubborn nature stems from multiple layers of complexity that must be addressed simultaneously. In the bullet points below, we'll explore each of these challenges so you can see why a broad, targeted approach is essential for lasting results.
- Chronic and Recurring Nature: Melasma is inherently relapsing; even successful clearance often gives way to new patches once triggers return.
- Depth of Pigment: Epidermal pigment may respond to topicals, but mixed or dermal melasma resists surface therapies and necessitates in-clinic procedures.
- Skin Irritation Risk: Many lightening agents can inflame and paradoxically exacerbate pigmentation if not paired with soothing protocols.
- Persistent Triggers: Daily sun exposure and ongoing hormonal fluctuations can lead to melasma persisting despite rigorous regimens.
Underlying Mechanisms Amplifying Melasma
Epidermal–Dermal Junction Disruption
When the basement membrane becomes damaged, melanocytes and pigment particles can penetrate deeper into the dermis, forming pendulous melanocytes. This dermal pigmentation is far more challenging to treat than superficial epidermal pigmentation.
Methylation Imbalance
Methylation acts like tiny switches on our DNA, quietly turning genes on or off without changing the genetic code itself. In melasma, these switches become stuck in the "on" position for pigment-making genes, causing melanocytes to produce excess pigment and flood the skin with colour. Sunlight can flip even more of these switches, deepening the tint. Still, treatments such as retinoic acid, niacinamide, and mineral-rich sunscreens work to reset them—soothing oxidative stress and gently coaxing those overactive switches back toward balance.
Gut Health & Constipation
Slow bowel motility prolongs oestrogen recirculation and raises systemic inflammation—both of which can indirectly fuel hyperpigmentation.
Vascular Influence
Melasma isn't just about excess pigment — your blood vessels play a significant role, too. Understanding the vascular component helps explain why topical treatments alone may not be enough. Treatments that also target inflammation and blood vessel overgrowth can offer better, longer-lasting results. Here's how increased vascular activity contributes to stubborn pigmentation:
- More Blood Vessels, More Pigment: Melasma-affected skin often has more and larger blood vessels. These vessels help deliver signals that activate melanocytes (pigment-producing cells).
- VEGF: The Pigment Messenger: Your skin produces VEGF (vascular endothelial growth factor). VEGF causes new blood vessels to form and widen, making it easier for pigment-triggering messages to reach the melanocytes (pigment-producing cells).
- Inflammation = More Pigment: Blood vessels release inflammatory chemicals, like histamine, that stimulate melanin production. Leaky capillaries cause ongoing inflammation, which worsens pigmentation.
Sun Exposure
Sun exposure is one of the primary triggers of melasma, and it does more than darken the skin. UV rays can increase blood vessel activity in the skin, potentially worsening pigmentation. This happens in a few ways:
- VEGF Production: UV rays increase a protein called VEGF, which causes new blood vessels to form.
- Increased Nitric Oxide: UVB light stimulates the production of nitric oxide, leading to widened blood vessels and increased melanin (pigment) production.
- Skin Barrier Damage: Ongoing UV exposure damages the skin's structure, leading to increased blood vessel growth and pigmentation.
This is why daily sun protection is essential when treating melasma, especially when increased vascularity is a contributing factor.
Hormonal Influences
Hormones play a significant role in the development of melasma, particularly in changes in blood vessels and increased pigmentation.
- Oestrogen increases blood vessel growth and makes pigment-producing cells (melanocytes) more active.
- Progesterone and luteinising hormone (LH) can also influence the skin's sensitivity to pigmentation, but to a lesser degree.
- Thyroid hormones, particularly in cases of thyroid disorders, have been linked to melasma and can affect pigmentation and blood flow in the skin.
Gut Health
Emerging research suggests a connection between chronic pigmentation, such as melasma, gut imbalances, including leaky gut syndrome, and inflammation. Poor gut health can lead to increased systemic inflammation, contributing to hormonal imbalances and oxidative stress, which can exacerbate hyperpigmentation.
Probiotics, prebiotics, anti-inflammatory foods, and eliminating gut disruptors like gluten, dairy, and sugar may help reduce flare-ups and improve skin clarity over time.
Melasma's resilience reflects the many layers of our skin and body—from the skies above to the currents within, and calls for more than a single remedy. At Skin Renewal, we blend science and empathy, guiding you through a personalised plan that unites sun-smart habits, targeted treatments and holistic support. Together, we'll illuminate each challenge, layer by layer, transforming persistent patches into a canvas of confidence and allowing your true radiance to shine through.
