Melasma Treatment in Hounslow
Melasma is treated gently and gradually — not aggressively. It is a chronic, hormonally driven form of pigmentation that appears as symmetrical brown or grey-brown patches, usually across the cheeks, forehead, and upper lip. Because melasma sits deep and reacts badly to heat and trauma, the wrong treatment can make it visibly worse. At Skin Health Practice in Hounslow, we manage melasma with the mesoestetic Cosmelan and Dermamelan depigmentation protocols, topical brightening actives such as tranexamic acid, and rigorous daily sun protection — a calm, layered approach designed to fade the patches you have and hold them down long-term. Melasma cannot be permanently cured, but with the right protocol it can be significantly reduced and kept under control. This page explains what melasma is, why it is so stubborn, why gentle beats aggressive, and exactly how we treat it.
Reviewed by Su Rixon · Aesthetic Clinician · Last reviewed April 2026
What Is Melasma?
Melasma appears as symmetrical, blotchy patches of brown or grey-brown discolouration, most commonly across the cheeks and cheekbones, the forehead, the bridge of the nose, the upper lip (giving a 'moustache' shadow), and sometimes the jawline and chin. Unlike a sun spot or a dark mark left by a spot, melasma is not a single discrete lesion — it forms diffuse, map-like areas with soft, indistinct borders, and it is almost always mirrored on both sides of the face. It is caused by overactive melanocytes (the skin's pigment-producing cells) depositing excess melanin. In many people the pigment sits in the upper (epidermal) layer, but in longstanding melasma it can reach deeper into the dermis, which is one reason it can be so difficult to shift. Melasma is far more common in women and in people with medium-to-deep skin tones — a pattern we see reflected every day in Hounslow and across West London's diverse community.
What Causes Melasma? Hormones, Heat and UV
Melasma is predominantly hormonal, which sets it apart from most other pigmentation. Oestrogen and progesterone stimulate melanocytes, so the condition is strongly linked to pregnancy — where it is often called the 'mask of pregnancy' or chloasma — as well as to the combined contraceptive pill and hormone replacement therapy. Layered on top of the hormonal driver are two powerful aggravators: UV light and heat. Ultraviolet exposure switches melanocytes into overdrive, and even short bursts of unprotected sun can reactivate melasma or undo weeks of progress. Heat alone — from hot weather, saunas, cooking over a stove, or even the warmth of certain devices held against the skin — can also worsen it, independent of UV. A family history of melasma raises your risk further. Because several of these triggers are hormonal and cannot simply be switched off, melasma tends to fluctuate and recur, which is why we treat it as an ongoing condition to be managed rather than a one-off problem to be zapped.
Why Melasma Is So Stubborn
Melasma has a reputation as one of the most frustrating skin conditions to treat, and that reputation is deserved. The pigment can be seated deep in the skin, beyond the reach of surface exfoliation. The underlying melanocytes are chronically overactive rather than simply damaged, so clearing the visible pigment does not switch off the cells that produced it — they will make more the moment they are provoked. And the main triggers, being hormonal and environmental, are difficult to eliminate entirely. This combination means melasma is highly prone to relapse. Realistic expectations matter: the goal is meaningful, visible fading and long-term control, achieved through a consistent protocol and disciplined sun protection, rather than a single treatment that makes it vanish forever. Clients who understand this from the outset get the best and most durable results.
Why Gentle Beats Aggressive — And Why Laser Can Make Melasma Worse
This is the single most important thing to understand about treating melasma. Aggressive, heat-based treatments — including many laser and IPL devices — can trigger a rebound, leaving melasma darker and more entrenched than before. Because melasma is aggravated by heat and by inflammation, a treatment that relies on thermal energy or causes significant skin trauma can provoke the very melanocytes you are trying to calm. This risk is greatest in exactly the skin tones most affected by melasma. For this reason we do not treat melasma with aggressive laser or IPL as a first-line approach. Instead we lean on biochemical depigmentation (Cosmelan and Dermamelan), topical brightening actives, gentle resurfacing where appropriate, and strict photoprotection — modalities that reduce pigment production without the heat and trauma that make melasma rebound. If you have been offered aggressive laser for melasma elsewhere, we would encourage a careful second opinion first.
Our Cosmelan-Led Approach to Melasma
Our primary tool for melasma is the mesoestetic Cosmelan depigmentation protocol — widely regarded as the gold standard professional treatment for this condition. Rather than burning or ablating the skin, Cosmelan works biochemically: it inhibits tyrosinase, the key enzyme in melanin production, at multiple points in the pathway. This both fades existing pigment and helps suppress new formation, which is exactly what a chronic condition like melasma needs. The protocol has two phases: an in-clinic mask application tailored to your skin, followed by an essential home-care maintenance phase using the Cosmelan 2 cream over several months. For more resistant or deeper melasma, the related Dermamelan protocol may be recommended. Because these work chemically rather than through heat, they are suitable across all skin tones. Alongside depigmentation we may layer in topical actives — tranexamic acid, azelaic acid, niacinamide and vitamin C — and gentle supporting therapies, always chosen to calm rather than inflame the skin. You can read more on our dedicated Cosmelan page.
Melasma on Darker Skin (Fitzpatrick III–V)
Melasma is most common in medium-to-deep skin tones — including South Asian, Middle Eastern, East Asian, Latin, and African heritage — which makes this a core area of expertise at our Hounslow clinic, serving Southall, Hounslow, Ealing, Hayes and the wider West London community. Darker skin needs particular care because it is more prone both to melasma itself and to post-inflammatory hyperpigmentation, meaning an over-aggressive treatment can leave new dark marks on top of the original problem. This is one of the most common reasons clients come to us after disappointing or damaging experiences elsewhere. Our approach for richly pigmented skin is deliberately conservative and heat-free: the Cosmelan or Dermamelan protocol as the backbone, carefully selected topical actives, patch testing before anything active, and a strong emphasis on daily sun protection. If you have been told your skin tone limits your options for treating melasma, it usually does not — it simply changes which treatments are safe and appropriate.
Sun Protection and Long-Term Maintenance
For melasma, sun protection is not an optional extra — it is arguably the most important part of the treatment. Because UV and visible light both drive melanocytes, a broad-spectrum SPF 50 applied every morning and reapplied through the day is essential from day one, and forever afterwards. We often recommend a tinted mineral SPF, as the iron oxides in tinted formulas help shield against the visible light that can aggravate melasma — something a plain clear sunscreen does not do as well. Beyond sunscreen, maintenance means using your prescribed home-care consistently, being mindful of heat exposure, and reviewing hormonal triggers with your GP where relevant (for example if you are on the pill and melasma is proving hard to control). Melasma that is 'clear' is really melasma that is well controlled; a light-touch maintenance routine keeps it that way and makes any future flare far easier to settle.
What to Expect at Skin Health Practice
Your melasma journey begins with a thorough consultation in Hounslow, where we confirm that your pigmentation is genuinely melasma (rather than sun damage or post-acne marks, which are treated differently), assess its depth and your skin type, and review your hormonal and sun-exposure history. We will be honest about realistic outcomes and timescales. If Cosmelan is appropriate, the in-clinic mask is applied and then removed at home following clear instructions, and you are sent away with your full home-care kit including SPF. Over the first week or so the skin may look flushed and flake gently as it renews. Visible lightening typically begins within a few weeks, with continued improvement over two to three months as the maintenance phase does its work. We review your progress at follow-ups and adjust the plan as your skin responds. We are located in Hounslow, West London, and your initial consultation is free.
Have Questions?
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Why Choose This Treatment
Key Benefits
Cosmelan and Dermamelan
Cosmelan and Dermamelan — the gold standard depigmentation protocols for melasma
Gentle
Gentle, heat-free approach that avoids the rebound risk of aggressive laser and IPL
Targets overactive melanocytes at
Targets overactive melanocytes at the source, not just surface pigment
Safe and appropriate for
Safe and appropriate for darker skin tones (Fitzpatrick III–V)
Structured treatment
Structured treatment-to-maintenance plan for long-term control of a chronic condition
Tailored home
Tailored home-care including tranexamic acid and mineral SPF guidance
Practitioners experienced in complex
Practitioners experienced in complex, hormonally driven pigmentation
Frequently Asked Questions
Have Additional Questions?
Get in touch and our team will be happy to help.
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Further reading & safety information
Independent, non-promotional guidance from UK health and professional bodies:
Take Control of Stubborn Melasma
Melasma is challenging, but it is manageable with the right, gentle approach. Book a specialist melasma consultation at Skin Health Practice in Hounslow and discover how our Cosmelan-led protocol can fade your pigmentation and keep it under control.