What melasma is
Melasma is a chronic, relapsing pigment condition. Pigment cells become overactive, although their number does not rise. Patches are symmetric and sit in centrofacial, malar or mandibular areas. It is also called chloasma or the mask of pregnancy.
Triggers include ultraviolet and visible light, heat, infrared and hormonal influences such as pregnancy and hormonal contraception. Singapore lies about one degree north of the equator, so ultraviolet stays high all year. Dr Sin Yong assesses you himself and treats only once the diagnosis is firm.
How melasma is assessed
Patches are examined in daylight-balanced and angled light, with dermoscopy and a Wood's lamp where needed. Depth is classed as epidermal, dermal or mixed. Melasma is then separated from sun spots, post-inflammatory marks, freckles and Hori's naevus, because these need different care. A changing, raised or unusual patch is referred for dermatological assessment.
What melasma treatment in Singapore includes
Tinted iron-oxide sunscreen, shade and avoiding heat form the base of the plan.
Hydroquinone in supervised cycles with planned breaks, and tretinoin.
Available as a topical cream. The oral form is prescription-only and considered after clotting-risk screening.
Pico toning or 1064 nm toning at low fluence, staged, with settings chosen for Fitzpatrick III to V skin.
R2 Glow uses long-pulsed 755 nm and 1064 nm.
Who this suits
It suits symmetric brown-grey patches confirmed as melasma, especially pigment that persists despite sunscreen alone. You need to be willing to combine trigger control, daily protection and topical care. You also need to accept a staged plan with reviews. If the diagnosis changes, the approach changes with it.
Who should wait or take care
Elective laser is generally deferred. Hydroquinone, tretinoin and oral tranexamic acid are usually avoided.
A personal or family history of blood clots or a clotting disorder matters. Smoking and combined hormonal contraception are reviewed before oral tranexamic acid.
Photosensitising medicine, a recent tan, active dermatitis, or irritation from strong actives.
Known allergy to a topical ingredient.
Laser is not started.
This is a poor fit if you want one-off clearance, or cannot keep up daily protection and heat avoidance.
What treatment cannot do
It is managed over time, and relapse is possible.
Pigment can return after a hot season, a pregnancy or a change of hormonal medicine.
Pico laser is an adjunct only. It does not control melasma.
Risks and side effects
Aggressive or heat-based laser can cause rebound darkening. Repeated low-energy toning of one area has been linked to pale, mottled spots that recover slowly. Irritation can leave post-inflammatory pigment. Creams can cause irritation, redness and peeling. Prolonged unsupervised hydroquinone can cause a bluish-grey darkening called exogenous ochronosis. Oral tranexamic acid can cause stomach upset, lighter periods and, rarely, blood clots. A National Skin Centre review of 561 patients found adverse effects in 7.1%, mostly transient. One patient had a deep vein thrombosis and was later found to have an inherited clotting disorder.
What recovery looks like
Maintenance
Daily sun protection carries on indefinitely, with reapplication and protection near windows indoors. Hydroquinone is stopped in a planned way. Azelaic acid, a retinoid or tranexamic acid may be used between courses. Reviews look for rebound, irritation and pale patches, and revisit hormones and heat.
Sessions and fees
The number of sessions and their spacing are discussed at consultation. Fees follow your plan, not a fixed list. They depend on assessment findings, the area involved, whether approaches are combined and how the plan is staged. A written quote is given at consultation, after assessment and before anything is agreed.