Melasma and the Maltese sun: why some pigmentation keeps coming back
Melasma is not ordinary sun damage. It is hormonal, it is triggered by heat and light, and the wrong laser can make it worse. How we treat it on an island with ten months of strong sun.
What melasma is
Melasma shows as symmetrical brown or grey-brown patches on the cheeks, forehead, upper lip and bridge of the nose. It is far more common in women, often starts in pregnancy or with hormonal contraception, and it is driven by three things at once: hormones, ultraviolet light, and heat.
That third trigger is the Maltese problem. Visible light and infrared heat stimulate pigment cells even through sunscreen, which is why melasma can darken on a hot day in the shade.
How it differs from sun spots
Sun spots (solar lentigines) are discrete, respond well to laser and tend to stay away once treated. Melasma is diffuse, sits in the epidermis and sometimes deeper in the dermis, and recurs with each summer. Treating it like a sun spot, with aggressive laser, often makes it worse.
The plan, in order
- Daily broad-spectrum SPF 50 with iron oxides, which block visible light. Reapplied. All year. This is the treatment; everything else supports it.
- A hat with a brim between April and October.
- Topical agents prescribed by a doctor: combinations that slow pigment production, used in courses with breaks.
- Gentle in-clinic procedures in the winter months: superficial peels and selected low-energy light treatments, chosen by skin type and tested on a patch first.
- Review of hormonal contraception with your doctor if it is a likely driver.
What we avoid
High-energy laser, heat-generating treatments in summer, and any promise of a permanent cure. Melasma is managed, not cured, and a good year is one in which it stays faint.
Seasonality
In Malta the active treatment window is roughly November to March. From April the aim shifts to maintenance: protection, topical agents and patience.
When to come in
If patches are new, spreading or asymmetric, see a doctor before any aesthetic treatment. Not all pigmentation is melasma, and some conditions need a different pathway.
Related: Sun, skin and the Maltese summer.
