Melasma · Fitzpatrick IV to VI · Battersea SW11
Melasma treatment in London. Pigment-aware protocols for darker skin.
Healthy skin for every tone. Our goal is even skin tone, not lighter skin. We do not offer bleaching or skin-whitening treatments. Melasma is chronic and recurring; we will be straight with you about what each treatment can and cannot do. We lead with sun protection and topicals, not aggressive devices.
A personalised consultation with Arman Zaki, GMC-registered Physician Associate (Ref A8131967), on the south side of Lavender Hill in Battersea, a short walk from Clapham Junction, serving melasma patients across South London. We build a structured plan around your Fitzpatrick type, melasma subtype, and lifestyle. Most in-clinic options at Melatone, chemical peels, polynucleotides, microneedling, are layered cautiously and only after topicals and sun protection have been set in place.
What it is
A chronic, hormonally and UV-driven pigmentation pattern.
Melasma is an acquired pigmentary condition that presents as symmetrical brown or grey-brown patches, most often across the cheeks, forehead, upper lip, nose, and chin. It is hormonally and UV-driven and disproportionately affects people with Fitzpatrick skin types III to VI. Triggers can include pregnancy, combined oral contraceptives, hormone replacement therapy, family history, and sun and visible-light exposure.
Melasma is currently considered a chronic, relapsing condition rather than a curable one. The realistic goal of treatment is to lighten the visible pigmentation, protect the result with rigorous sun-protection coaching, and provide a structured maintenance plan you can follow long-term. We will be honest about this at consultation.
Why darker skin needs a different approach
Conservative first. Then layered cautiously.
In Fitzpatrick IV to VI skin, aggressive depigmenting devices and high-strength peels carry a meaningful risk of post-inflammatory hyperpigmentation (PIH), a rebound darkening that can leave skin worse than it started. Published dermatology guidance generally cautions against IPL and many laser pigment-removal protocols for melasma in darker skin types specifically. We follow that guidance.
Our approach is a conservative treatment ladder. We start with the two interventions with the strongest evidence base and the lowest risk profile: rigorous broad-spectrum sun protection (SPF 50+ with visible-light coverage), and prescribed topical depigmenting agents. We then layer in low-strength superficial chemical peels, polynucleotide skin-quality support, and microneedling at melanin-aware parameters where indicated, always after a patch test, always with photographic baselines.
The treatment ladder
What we may use at Melatone.
Each layer is added cautiously after the previous one has been established. Not every patient receives every layer. Your plan is built at consultation.
01 · Foundation
Daily broad-spectrum SPF 50+ with visible-light coverage.
Melasma is driven by both UV and visible light, so a tinted mineral SPF that filters visible light (iron oxides) tends to outperform a colourless chemical SPF in pigmented skin. Daily reapplication is non-negotiable, including indoors near windows.
02 · Topical regimen
Personalised prescribed topicals.
Tyrosinase inhibitors, retinoids, and where appropriate hydroquinone, prescribed and sequenced based on your skin's tolerance. Topicals are the workhorse of melasma management.
03 · In-clinic, layered cautiously
Low-strength superficial chemical peels.
Gentle, sequenced superficial peels selected for safety in Fitzpatrick IV to VI. We patch test, we start low, we monitor closely. Aggressive medium-depth peels are generally not used for melasma in darker skin.
04 · Skin-quality support
Polynucleotides (Nucleofill).
Polynucleotides are not a depigmenting agent. They are a regenerative skin-quality treatment that may improve barrier function, hydration, and overall skin resilience, useful adjuncts when the melasma sits in skin that is also dry, fragile, or inflammation-prone.
05 · Where indicated
Microneedling with melanin-aware parameters.
Microneedling for melasma is debated in the literature. We use it selectively, with conservative pass numbers and short needle depths, and always after a patch test and trial in Fitzpatrick IV to VI. We do not aggressively channel into pigmented skin.
06 · Where indicated
Exosomes (where indicated).
Published clinical evidence for exosomes specifically in melasma is currently limited; we will discuss the strength of the evidence honestly at consultation and only recommend exosomes where the rationale is clear.
What the evidence says
Hydroquinone, the alternatives, and how they compare.
If you have researched melasma, you have met the same debate the studies have: is prescription hydroquinone still the benchmark, or have the newer agents caught up? Here is an honest reading of where the evidence sits, so your choice at consultation is an informed one rather than a marketed one.
| Approach | What the evidence shows | Where it fits |
|---|---|---|
| Hydroquinone (topical) Especially triple combination |
The most studied topical for melasma and widely regarded as first-line, particularly the triple combination of hydroquinone with a retinoid and a mild steroid. Prescription-only in the UK. | A first-line option under clinical supervision, used in courses rather than indefinitely. |
| Non-hydroquinone topicals Azelaic acid, tranexamic acid, cysteamine, niacinamide, kojic acid, vitamin C |
Several can meaningfully reduce pigment and some approach hydroquinone in trials, but head-to-head evidence is more limited and mixed. | Useful where hydroquinone is unsuitable, and for long-term maintenance between courses. |
| Oral tranexamic acid Supervised only |
Evidence supports a role in selected moderate to severe cases, with screening and clinical supervision. Not a first step. | Considered case by case, never a default. |
| Professional depigmentation systems In-clinic layered protocols |
These clinic-applied protocols can help some patients, but data directly comparing them with prescription hydroquinone are limited and mostly lower quality. | A clinic option where the evidence and your skin type support it, decided at consultation. |
| Peels and energy devices Adjuncts at most |
Adjuncts at most for melasma, and higher-risk in darker skin. No device replaces the topical and sun-protection foundation. | Layered cautiously, and only after the foundation holds. |
The honest summary. No single active is proven best for everyone. Prescription hydroquinone remains the most evidence-backed topical, the alternatives are valuable especially for maintenance and for skin that cannot use hydroquinone, and every option depends on daily sun protection to hold its result. The right choice depends on your melasma subtype, your Fitzpatrick type, and your triggers, which is exactly what the consultation is for.
Independent background reading: British Association of Dermatologists: melasma and DermNet: melasma.
What we usually don't lead with
For melasma in Fitzpatrick V to VI, we don't lead with these.
Published dermatology guidance generally cautions against the following in darker skin types for melasma specifically, because of PIH and rebound risk:
- · IPL pigment-removal protocols in Fitzpatrick V to VI.
- · Aggressive Q-switched laser settings for general pigmentation.
- · Medium-depth or deep chemical peels for melasma in darker skin.
- · Single-session "miracle" device treatments without a topical foundation and sun-protection baseline.
If, after topicals and superficial peels have been tried, low-fluence 1064nm Nd:YAG laser is considered, it is only in very conservative settings, after a patch test, and only where the risk-benefit is clearly favourable. The default at Melatone is conservative, not aggressive.
The layered melasma protocol
How the layers stack, and what each one is for.
Melasma in Fitzpatrick IV to VI responds to a sequence, not a single device. We build the foundation first and let it hold before any energy-based step is added. Nothing here is escalated without a patch test and a photographic baseline. Not every layer is right for every patient.
| Layer | What it does | Skin of Colour caution |
|---|---|---|
| 01 · Sun protection Foundation, always |
Daily SPF 50+ with visible-light (iron-oxide) cover. The single highest-yield step, and the one that protects every result that follows. | Low risk. Tinted mineral filters tend to outperform colourless chemical SPF in pigmented skin. |
| 02 · Topicals The workhorse |
Prescribed depigmenting agents, sequenced to your tolerance. This layer does most of the lightening work over weeks. | Introduced gradually to avoid irritation, which itself can drive post-inflammatory pigment in darker skin. |
| 03 · Gentle peels In-clinic, cautious |
Low-strength superficial peels only, added once the foundation holds. Start low, build slowly, monitor closely. | Medium-depth and deep peels are generally not used for melasma in Fitzpatrick IV to VI. We patch test first. |
| 04 · Microneedling Selective |
Used selectively with conservative pass numbers and short needle depths, after a patch test and trial. | Debated in the literature. We do not aggressively channel into pigmented skin. Trialled before committing to a course. |
| 05 · Gentle laser Last, if at all |
Where considered, low-fluence 1064nm Nd:YAG only, and only after topicals and peels have been tried first. | Highest caution. IPL and aggressive pigment-removal settings carry real rebound and PIH risk in Fitzpatrick V to VI; we do not lead with them. |
Triggers to avoid
What makes melasma worse.
- · Unprotected sun and even bright daylight near windows. UV and visible light both drive pigment.
- · Skipping or under-applying SPF, or stopping it in winter.
- · Heat: saunas, hot yoga, steam, and prolonged kitchen heat can flare melasma.
- · Harsh scrubs, strong acids, and over-exfoliation that inflame the skin.
- · Aggressive lasers, IPL, and medium or deep peels on darker skin types.
- · Picking, waxing, or any avoidable trauma to affected areas.
The hormonal context
Worth knowing before we start.
- · Pregnancy and breastfeeding are common triggers, and most in-clinic steps pause during them.
- · Combined oral contraceptives and hormone replacement therapy can drive or sustain melasma. Tell us what you take.
- · Recurrence after sun, pregnancy, or hormonal change is well documented. Maintenance is part of the plan, not a failure of it.
The consultation
£30, deducted from your first treatment.
One
Assessment
Fitzpatrick typing, melasma subtype (epidermal, dermal, mixed), trigger history, current skincare and SPF habits, hormonal context. Photographic baseline taken at consistent lighting.
Two
Personalised plan
Written sequenced plan: foundation layer first, in-clinic add-ons second. Review schedule. Honest reading of what the evidence supports and where it stops.
Three
Review at 4 to 6 weeks
Photographic comparison, plan adjustment, decision to escalate or hold. Quarterly maintenance reviews after that.
Finding us in Battersea
Unit 13A, Battersea Business Centre, SW11 5QL.
On the south side of Lavender Hill, at the junction with Latchmere Road, in the London Borough of Wandsworth. 10 to 14 minutes on foot from Clapham Junction, or a short bus down Lavender Hill. Battersea Park station is also nearby. We treat melasma for patients from across South West London, Clapham, Wandsworth, Battersea Park and Nine Elms among them. Bus routes 77, 87, 156, 345 stop within two minutes of the door (night services N77 and N345). Pay-and-display parking on Lavender Hill and Latchmere Road.
Questions, answered honestly
Before you book.
Can melasma be cured?
Melasma is currently considered a chronic, relapsing pigmentary condition rather than a curable one. Most patients can achieve substantial visible improvement with a consistent personalised programme of daily sun protection, prescribed topical agents, and selected in-clinic treatments, but recurrence after sun exposure, pregnancy, or hormonal changes is well-documented in the published literature. We will be honest about realistic expectations during your consultation. Our approach is to reduce the visible pigmentation, protect the result with rigorous sun-protection coaching, and provide a structured maintenance plan you can follow long-term.
Is laser safe for melasma on darker skin (Fitzpatrick V to VI)?
Most lasers used for general pigmentation carry a higher risk of post-inflammatory hyperpigmentation (PIH) and rebound melasma in Fitzpatrick V to VI skin. Published guidance generally cautions against IPL and aggressive laser pigment-removal in darker skin types for melasma specifically. We do not lead with laser for melasma in Fitzpatrick V to VI. We lead with topicals, sun protection, low-strength superficial peels, polynucleotides, and where indicated microneedling with melanin-aware parameters.
What treatments do you offer at Melatone for melasma?
We build a personalised plan from the following options: daily broad-spectrum SPF 50+ with visible-light coverage, prescribed topical depigmenting agents (tyrosinase inhibitors, retinoids, hydroquinone where appropriate), low-strength superficial chemical peels layered cautiously, polynucleotide injections for skin barrier and overall skin-quality support, and microneedling with melanin-aware parameters where indicated. Treatment is delivered by Arman Zaki, GMC-registered Physician Associate, with a special interest in Skin of Colour. The exact protocol is tailored to your Fitzpatrick type, melasma subtype, hormonal triggers, and lifestyle factors.
How long until I see a difference?
Most patients begin to see gradual lightening of pigmentation between weeks four and eight of a consistent topical and sun-protection programme, with more visible change at twelve weeks if in-clinic treatments are added in. Melasma is slow by nature, the pigment sits in the dermal and epidermal layers and is influenced by sun, hormones, and inflammation. Photographic comparison at consistent lighting at the four-week and twelve-week mark is the most reliable way to track progress. Individual results vary.
Is melasma treatment safe in pregnancy or breastfeeding?
Pregnancy and breastfeeding are common melasma triggers, but the majority of in-clinic procedures and many prescribed topicals are not appropriate during these periods. We do not deliver chemical peels, polynucleotides, or microneedling during pregnancy or breastfeeding, and hydroquinone and retinoids are contraindicated in pregnancy. We can offer a conservative skincare and sun-protection programme using pregnancy-safe ingredients, photographic monitoring, and a structured plan to resume in-clinic treatments once you have finished breastfeeding.
Who delivers melasma treatment at Melatone?
Arman Zaki, the founder and lead clinician of Melatone Skin Clinic, GMC-registered Physician Associate (Ref A8131967), with NHS general practice experience. Arman offers personalised skin consultations across a wide range of conditions including melasma and other pigmentation disorders, and delivers microneedling, chemical peels, PRP, skin boosters, polynucleotides, and other regenerative skin solutions.
What is the safest way to treat melasma on darker skin tones?
The safest way to treat melasma on darker skin tones (Fitzpatrick IV to VI) is to start gently and avoid anything that can trigger rebound pigmentation. Daily broad-spectrum SPF 50 with visible-light cover is the foundation, followed by prescribed topical pigment regulators and, where suitable, low-strength superficial peels formulated for darker skin. Aggressive lasers and IPL are generally avoided for melasma in darker skin because they can make it worse. Arman Zaki confirms your melasma subtype and Fitzpatrick type before starting, because the wrong treatment can darken melasma further. See DermNet: melasma and the DFTB Skin Deep image library (clinical images across diverse skin tones) for background. Book a consultation and patch test first.
Is hydroquinone the best treatment for melasma?
Hydroquinone, particularly the triple combination of hydroquinone with a retinoid and a mild steroid, is the most studied topical treatment for melasma and is widely regarded as first-line. In the UK it is prescription-only and used in supervised courses rather than indefinitely. It is not automatically right for everyone. The best choice depends on your melasma subtype, your Fitzpatrick type, whether you are pregnant or breastfeeding, and how your skin tolerates it. At Melatone we assess this at consultation and prescribe hydroquinone only where it is appropriate, alongside daily sun protection which protects any result.
What are the alternatives to hydroquinone for melasma?
Several non-hydroquinone options can help, including azelaic acid, topical tranexamic acid, cysteamine, niacinamide, kojic acid, and vitamin C, and in selected moderate to severe cases oral tranexamic acid under clinical supervision. Some approach hydroquinone in studies, though head-to-head evidence is more limited. These are especially useful for long-term maintenance and for skin that cannot use hydroquinone. Professional in-clinic depigmentation systems also exist, though data comparing them directly with prescription hydroquinone are limited. Whichever active is used, daily broad-spectrum SPF 50 with visible-light cover is the foundation, and a clinician confirms the plan for darker skin.
Editor's choice reading
Before you book a consultation.
Special interest
Skin of Colour. Why melanin-rich skin needs a different protocol, and how we build one.
Our special interest, for Fitzpatrick IV to VI.
Journal article
The at-home routine for pigmentation in Skin of Colour. What actually helps between appointments.
Over-the-counter ingredients, SPF, and what to avoid.
Related treatment
Chemical peels in Battersea. The low-strength superficial peels we layer cautiously for melasma.
How we patch test, start low, and monitor.
Related treatment
Microneedling in Battersea. Melanin-aware parameters and where it fits in a melasma plan.
Conservative depths, selective use, patch tested first.
Related condition
Post-inflammatory hyperpigmentation. The dark marks left after spots, and how it differs from melasma.
Often confused with melasma, treated differently.
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Important information
This page describes a regulated aesthetic medical service. Melasma is a chronic, relapsing pigmentary condition; no aesthetic treatment guarantees clearance, and recurrence is common with sun exposure, pregnancy, and hormonal changes. Individual results vary. Treatments described are personalised and delivered after an in-person clinical assessment. Hydroquinone and retinoids are prescribed only where appropriate and are contraindicated in pregnancy and breastfeeding. Melatone Skin Clinic Ltd, Unit 13A, Battersea Business Centre, 99-109 Lavender Hill, London SW11 5QL. For complaints or concerns, contact the clinic directly.
Continue at home
What we use in clinic, now on your shelf
Even, luminous tone needs the right daily actives. This is the pigmentation homecare we build most routines around, with free UK delivery over £65.