After the age of 35, many women experience a dramatic decline in their skin condition.
Despite using expensive skincare products, it becomes increasingly difficult to conceal the marks left by time. Modern women face tremendous pressure from work and life—managing both career and household responsibilities. Long-term habits such as staying up late, skipping breakfast, binge eating, preference for spicy food, emotional instability, frequent anxiety, depression, or irritability can all lead to liver Qi stagnation in traditional Chinese medicine.
Main Manifestations
Melasma typically presents as clearly defined, irregular brown or dark-brown patches, most commonly found on the face of middle-aged women. These patches often appear symmetrically on sun-exposed areas. A butterfly-shaped distribution across the cheeks and cheekbones is common, but lesions can also occur on the forehead, nose, and around the mouth.
01 Causes of Melasma
1. Ultraviolet radiation (UV):
UV light directly increases melanin production and also induces oxidative stress, leading to the formation of lipid peroxides and malondialdehyde—both of which promote melanogenesis.
2. Skin barrier damage:
UV radiation damages keratinocytes, causing structural and functional abnormalities. This triggers neurogenic factors that stimulate melanocyte activity. UV exposure also strengthens the pigment barrier as a compensatory response, further increasing melanin production.
3. Inflammatory response:
Inflammatory mediators stimulate melanin deposition. For example, acne lesions often leave post-inflammatory hyperpigmentation due to excess melanin. Inflammation also activates collagenase, which damages the basement membrane and allows melanin granules to drop into the dermis.
Overall, these three major factors directly or indirectly increase melanin production. UV exposure remains the number one trigger.
4. Nitric oxide imbalance:
In melasma, elevated nitric oxide synthase increases nitric oxide release. This leads to vasodilation and local inflammation and promotes the formation of new blood vessels. Meanwhile, various transcription factors and proteases further drive melanogenesis.
5. Hormonal fluctuations:
Pregnancy, menstrual irregularities, and oral contraceptive use can cause melasma due to changes in hormone levels.
6. Genetic predisposition:
About one-third of patients have a family history of melasma.
7. Visible light exposure:
Non-UV heat or light sources such as blue light from mobile phones and computers may also trigger or worsen melasma.
02 How to Prevent Melasma
Melasma patients should pay special attention to sun protection. Use hats, sunglasses, and other protective accessories during strong sunlight to reduce UV exposure.
They should also minimize exposure to cooking heat or occupational heat sources, avoid skincare products containing excessive mercury or lead, and avoid medications that may affect hormone levels or increase photosensitivity.
Maintaining adequate sleep, managing stress, following a balanced diet, and using cosmetics cautiously are also important preventive measures.
03 How to Treat Melasma
Melasma can be treated with topical medications, systemic medications, or laser-based therapies.
Oral medications often include tranexamic acid, vitamin C, and vitamin E.
Tranexamic acid is internationally recognized for its multiple effects such as inhibiting melanin synthesis and transport, reducing inflammation, counteracting photoaging, and repairing the skin barrier—collectively helping reverse melasma-related skin abnormalities.
Laser therapy works by targeting melanin granules with specific wavelengths. The absorbed energy causes rapid fragmentation of melanin, which is then cleared by macrophages.
Common laser modalities include Q-switched lasers and intense pulsed light (IPL).
Q-switched Nd:YAG laser
Uses the principle of subcellular selective photothermolysis. Low-energy pulses cause micro-explosions of melanin granules, making them easier for macrophages to remove. This non-ablative method has fewer risks and side effects compared with ablative fractional lasers.
CC Phototherapy / IPL (400–1200 nm)
As a broad-spectrum pulsed light, IPL is based on selective photothermolysis and photomodulation.
Its millisecond pulse duration is much longer than the thermal relaxation time of melanin granules, so it does not destroy melanin directly. Instead, it accelerates the metabolism of keratinocytes containing melanin, gradually lightening pigmentation.