Melasma Treatment Singapore —
A Staged Plan, Not A Single Pass

Melasma is a pigment system that has been switched to overproduce, not a deposit that can be scraped away. The melasma condition guide explains the biology. For treatment, it helps to see three separate targets.

The first is the triggers: ultraviolet light, visible light, heat and hormones. The second is pigment production, which prescription creams slow down. The third is the pigment already visible, which a laser can help lift. A plan that starts with the third target and ignores the first two usually ends with the patch returning, often darker, because the laser's heat is itself a trigger.

That is why melasma in Asian skin is treated in this order, and why melasma in Asian skin behaves differently from melasma in fairer skin.

Each stage is a checkpoint. If the skin flares, the plan steps back rather than adding energy.

Laser has a supporting role. Pigment cells in melasma respond to heat as a threat, so aggressive settings, small spot sizes, short intervals and repeated toning of the same area can all bring the patch back darker, or leave pale, mottled spots that recover slowly.

Used well, laser lifts some of the visible pigment while creams and sun protection hold production down. At Atelier the usual choices are laser toning at low fluence or a conservatively dosed pico laser, with settings for Fitzpatrick III to V skin. In selected faces, Dr SY may include the FSX Laser LCLR after assessment. Laser is deferred if the skin is tanned or irritated.

Suits: symmetrical brown or grey-brown patches confirmed as melasma, which have persisted despite sunscreen alone, in someone willing to combine sun and heat control with creams and a staged plan.

Should wait:

• Pregnancy or breastfeeding: elective laser is deferred, and hydroquinone, tretinoin and oral tranexamic acid are usually avoided.
• A personal or family history of clots, or a known clotting disorder: oral tranexamic acid is avoided. Smoking and combined hormonal contraception are also taken into account.
• A recent tan, active dermatitis, irritation from strong actives, or a photosensitising medicine.
• A known allergy to a proposed cream ingredient.

Patches that are raised, changing or unusual, or that turn out not to be melasma, are sent for dermatological assessment rather than treated.

1. Dr SY checks the patches against your last photographs, which are kept in your medical record with consent.
2. He asks about sun, heat, new products and any hormonal change since the last visit.
3. If the skin is tanned, irritated or flaring, the laser is postponed and the creams adjusted instead.
4. Make-up is removed and the skin cleansed.
5. Dr SY treats a test area or the planned zones at low energy, stopping at a mild endpoint.
6. Tinted sunscreen goes on before you leave, and the cream schedule is confirmed in writing.

After a conservative pass, expect mild redness or warmth that fades within hours. Start sun protection the same day. Over the following days, any dryness, redness or peeling from the creams is reported and the schedule adjusted; it is not something to push through. Lightening is gradual and often uneven, and a flare is a reason to reassess rather than repeat. Practical day-to-day care is on melasma treatment aftercare.

• Laser: rebound darkening, post-inflammatory hyperpigmentation, and pale mottled spots after repeated toning.
• Creams: irritation, redness and peeling, mainly from tretinoin or hydroquinone. Long, unsupervised hydroquinone use can cause a bluish-grey darkening called exogenous ochronosis, which is hard to reverse.
• Oral tranexamic acid: stomach upset and lighter periods; rarely, a blood clot, which is why screening comes first.

These risks are reduced by confirming the diagnosis, screening for clotting risk, using supervised prescription courses, keeping laser settings conservative and checking progress before any step up.