Melasma is a commonly acquired pigmentary disorder and a specific form of hyperpigmentation characterised by symmetrical, ill-defined brown or grey-brown patches that most commonly appear on the cheeks, forehead, upper lip and around the eyes.1 Although it is frequently associated with pregnancy, melasma has a multifactorial aetiology and can be triggered by hormonal fluctuations, genetic predisposition, ultraviolet (UV) radiation, visible light, heat exposure, certain medications such as oral contraceptives and psychological stress.1
What is melasma?
At a cellular level, melasma develops when melanocytes become overstimulated, leading to increased melanin production. Melanin is synthesised within melanosomes before being transferred to neighbouring keratinocytes, resulting in the visible accumulation of pigment within the skin. Once established, this dysregulated pigment production can be persistent and notoriously difficult to treat.1
Melasma Presentation in Asian Skin
Melasma is particularly common in individuals with darker skin phototypes (Fitzpatrick skin types III-V), including many East Asian (e.g. Chinese, Japanese and Korean) and Southeast Asian populations.1,2 This increased susceptibility is thought to reflect greater baseline melanocyte activity, making pigment producing cells more responsive to triggers such as ultraviolet (UV) radiation, visible light and heat.1 Reported prevalence rates in some Asian populations are as high as 40%.3
The condition predominantly affects women, although approximately 10% of cases occur in men.4,5,6 A national survey conducted in West Asia reported the highest prevalence among individuals aged 30-40 years.5
The Chronic Burden of Melasma
Melasma is a chronic, relapsing condition. Increased melanocyte responsiveness, combined with ongoing exposure to environmental triggers such as ultraviolet (UV) radiation, visible light and heat, means that even after successful treatment, melanocytes can be reactivated, resulting in recurrence.1 This highlights the importance of long term management strategies, including photoprotection and laser treatments.
Beyond its physical presentation, melasma can have a profound psychological impact. A global meta-analysis examining depression among people with melasma found the highest prevalence in Asian populations, with almost half (48.5%) experiencing depressive symptoms.7 Individuals with melasma frequently report embarrassment, reduced self-esteem, diminished quality of life and social withdrawal, emphasising that effective management should consider both the physical and psychosocial burden of the condition.2
Managing Melasma in Asian Skin
Photoprotection is the cornerstone of both melasma prevention and long term management. Daily use of a broad-spectrum sunscreen with a high SPF helps protect against ultraviolet (UV) radiation, while minimising exposure to heat, including avoiding activities such as saunas and steam rooms where possible can reduce ongoing stimulation of melanocytes and help prevent further darkening of existing pigmentation.
Although these strategies are essential for preventing progression and recurrence, melasma can be challenging to treat with sun protection and topical products alone. Given its chronic and recurrent nature, many patients benefit from assessment by a dermatologist or qualified aesthetic practitioner, who can develop an individualised treatment plan using advanced laser and energy-based technologies where appropriate.
A Higher Risk of Pigmentary Complications
The higher baseline melanin content found in many Asian skin types also influences how the skin responds to laser treatment. While laser and energy-based devices can be highly effective, darker skin phototypes have a greater risk of pigmentary complications if inappropriate technologies or treatment parameters are used. Potential adverse effects include prolonged erythema, blistering, hypopigmentation and post-inflammatory hyperpigmentation (PIH).8 Careful patient assessment, appropriate device selection and conservative treatment settings are therefore essential to optimise outcomes while minimising adverse effects in Asian skin.
Laser Treatment for Melasma
Earlier long pulse laser technologies generated greater thermal injury, increasing the risk of scarring and unwanted pigmentary changes.9 In contrast, picosecond laser technology delivers ultra-short pulses of energy that fragment pigment more efficiently while minimising thermal damage to the surrounding tissue in Asian skin.9
Among picosecond devices, both 1064 nm and 755 nm wavelengths have demonstrated favourable outcomes in the treatment of melasma.10 Clinical studies have shown that 1064 nm picosecond lasers can achieve significant reductions in pigmentation while safely treating all Fitzpatrick skin phototypes due to their deeper penetration and reduced epidermal absorption.9 Picosecond systems incorporating a 1064 nm wavelength and specialised toning handpieces, enabling treatment with larger spot sizes and low fluence settings to selectively target melanin while minimising injury to surrounding tissue. This approach may help reduce the risk of rebound pigmentation, an important consideration in the long term management of melasma.10
Similarly, PicoSure Pro represents an important milestone in laser treatment for melasma, becoming the first picosecond laser to receive FDA clearance for the treatment of melasma. Using a 755 nm wavelength, PicoSure Pro has demonstrated favourable efficacy and safety in the treatment of benign pigmented lesions, including melasma, supported by a growing body of clinical evidence. Collectively, the Cynosure Lutronic portfolio offers clinicians evidence based picosecond laser technologies that enable a tailored approach to melasma treatment, supporting effective pigment reduction while prioritising safety across a range of skin phototypes.
Final Thoughts
Melasma remains one of the most challenging pigmentary disorders to manage, particularly in Asian skin where increased melanocyte activity and heightened susceptibility to post-inflammatory hyperpigmentation contribute to its chronic and recurrent nature. Combined with the significant psychological burden associated with the condition, effective treatment extends beyond improving skin appearance, it has the potential to restore confidence, improve quality of life and reduce the long-term impact of living with a visible skin condition.
Historically, the risk of pigmentary complications limited the use of laser treatments in darker skin phototypes. However, advances in picosecond laser technology have transformed the treatment landscape, providing clinicians with safer, more targeted approaches to pigment removal while minimising thermal injury to surrounding tissue. The growing body of clinical evidence supporting technologies such as PicoSure Pro reflects how far laser medicine has progressed, offering practitioners greater confidence when treating melasma across a diverse range of skin phototypes.
As our understanding of melasma continues to evolve, combining appropriate patient selection, rigorous photoprotection and evidence-based laser technologies offers the greatest opportunity to achieve meaningful, long-term improvements while reducing the risk of recurrence. For many patients living with the physical and emotional burden of melasma, these advances represent an important step towards safer, more effective and more personalised care.
References:
1. Sathe NC, Launico MV. Melasma. In: StatPearls. StatPearls Publishing; Updated January 31, 2026. Accessed June 29, 2026. https://www.ncbi.nlm.nih.gov/books/NBK459271/
2. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014 Sep-Oct;89(5):771-82. https://pmc.ncbi.nlm.nih.gov/articles/PMC4155956/
3. Liu W, Chen Q, Xia Y. New Mechanistic Insights of Melasma. Clin Cosmet Investig Dermatol. 2023 Feb 13;16:429-442. https://pmc.ncbi.nlm.nih.gov/articles/PMC9936885/
4. Wu MX, Antony R, Mayrovitz HN. Melasma: A Condition of Asian Skin. Cureus. 2021 Apr 10;13(4):e14398. https://pmc.ncbi.nlm.nih.gov/articles/PMC8110291/#sec3
5. Hizli P, Kiliç FA, İçöz Aytaç S. Melasma Revisited: National Survey Reveals How Dermatologists Diagnose and Treat This Complex Skin Condition. J Cosmet Dermatol. 2025 Jan;24(1):e16630. https://pubmed.ncbi.nlm.nih.gov/39410770/
6. R, Darshan & Sood, Richa & Tiwari, Prashant. (2025). Melasma Management: Unveiling Recent Breakthroughs through Literature Analysis. Health Sciences Review. 14. https://www.sciencedirect.com/science/article/pii/S2772632025000054
1. Chen W, Wan Y, Sun Y, Gao C, Li J. Prevalence of depression in melasma: a systematic review and meta-analysis. Front Psychiatry. 2024 Jan 8;14:1276906. https://pubmed.ncbi.nlm.nih.gov/38260775/
2. Kono T, Shek SY, Chan HH, Groff WF, Imagawa K, Akamatsu T. Theoretical review of the treatment of pigmented lesions in Asian skin. Laser Ther. 2016 Oct 1;25(3):179-184. https://pmc.ncbi.nlm.nih.gov/articles/PMC5108992/
3. Kono T, Shek SY, Chan HH, Groff WF, Imagawa K, Akamatsu T. Theoretical review of the treatment of pigmented lesions in Asian skin. Laser Ther. 2016 Oct 1;25(3):179-184. https://pmc.ncbi.nlm.nih.gov/articles/PMC5108992/
4. Cynosure Lutronic EMEA. Melasma laser treatment. https://www.cynosurelutronicemea.com/skin-concerns/melasma/
*This article was originally published on Cynosure Lutronic APAC and is republished here with permission. Read the original article here.
