Brown or grey facial patches are often described simply as “pigmentation”, but they do not all behave in the same way. A sun spot may respond differently from melasma, and a laser treatment that is appropriate for one concern may be unsuitable for another.

So, can laser make melasma worse? Yes, it can in some people. Laser and light treatments may help selected cases when used within a carefully planned medical or dermatology-led approach, but melasma is reactive and prone to recurrence. Treatment can also trigger post-inflammatory hyperpigmentation, particularly when the diagnosis, device, settings or timing are not appropriate.

Why melasma is different from a sun spot

Melasma usually appears as flat, symmetrical brown or grey-brown patches, commonly on the cheeks, forehead, upper lip or chin. The British Association of Dermatologists explains that ultraviolet light can trigger or worsen it; hormones, pregnancy, some medicines and family tendency may also contribute.

Unlike an isolated sun-related mark, melasma is not simply a piece of pigment that can always be “removed”. Its activity can change with the season, sun exposure, hormonal factors and skin irritation. Even when it improves, it often returns. This is why identifying the likely type of pigmentation matters before choosing a procedure.

A new, changing, irregular, raised, bleeding or otherwise concerning pigmented lesion should not be treated cosmetically until it has been medically assessed.

How laser may worsen pigmentation

Laser and intense pulsed light treatments deliver energy into the skin. The intended target and response depend on the wavelength, pulse duration, energy, treatment depth and the person’s skin. Heat and inflammation can stimulate pigment production in susceptible skin, leading to post-inflammatory hyperpigmentation. Less commonly, treatment may cause areas of reduced pigment.

The risk is influenced by skin tone, recent tanning or sun exposure, the activity of the melasma, previous pigment reactions, skincare, medicines and the device and protocol used. Simply reducing the energy does not make every treatment suitable, and repeating sessions too quickly can add irritation.

Expected short-term effects can include redness, warmth, swelling or temporary darkening. Burns, blistering, prolonged pigment change, infection or scarring are less common but possible. Patients should contact their treating clinic promptly if pain is increasing, blistering develops or the skin is not healing as expected.

What does current research say?

Evidence for lasers in melasma is mixed, and results from one device should not be transferred automatically to another. A 2026 randomised, placebo-controlled split-face study examined a low-fluence Q-switched 1064 nm Nd:YAG protocol alongside a prescription topical regimen and sunscreen. Both sides improved, but the laser side did not show a significant additional benefit at most assessments, and patient-reported improvement had reduced by the six-month follow-up.

A 2026 review of five small randomised trials involving 139 patients assessed a 755 nm picosecond alexandrite laser. It found that a prescription combination cream produced a greater reduction in melasma severity and that post-inflammatory hyperpigmentation was more common with the laser. The authors rated the certainty of evidence as low because the trials were small and varied.

These findings do not mean every laser protocol will fail or cause harm. They do show why “laser removes melasma” is too broad a promise. The device, comparison treatment, skin types studied and follow-up period all matter.

What should a pigmentation consultation check?

Before considering laser for facial pigmentation, a consultation should cover:

  • the appearance, location and history of the patches;
  • pregnancy, hormonal factors, medicines and medical history;
  • skin tone, recent sun exposure or tanning and previous pigment reactions;
  • current skincare and recent peels, needling or energy-based treatments;
  • whether medical assessment or referral is needed before cosmetic treatment; and
  • realistic outcomes, recurrence, recovery and the possibility of no treatment.

Daily light protection is central to melasma management. The BAD advises broad-spectrum SPF 30 or above with strong UVA protection, alongside hats, shade and avoiding sunbeds. Products containing iron oxides may add protection against visible light. Sunscreen supports a plan; it does not provide complete protection or guarantee that melasma will not return.

Frequently asked questions

Does darker skin always rule out laser?

No, but melanin in the surrounding skin can affect risk and treatment choices. Skin tone, the diagnosis, the specific device and a person’s history of pigment change all need consideration.

Can melasma be permanently removed?

There is currently no guaranteed cure. Melasma may improve, remain stable or recur, so maintenance and trigger management often matter as much as the initial treatment.

Is Cosmelan the same as laser treatment?

No. Cosmelan is a professional depigmentation programme with planned home care. It also requires assessment and can cause redness, dryness, sensitivity and peeling. It is not suitable for every person or every pigmented lesion.

Discuss pigmentation near Preston

If you are based in Preston, Longridge or the wider Ribble Valley, begin with an assessment rather than choosing a device from a photograph. Read our guide to melasma versus sun spots, explore Defyne’s pigmentation consultation page, or learn about the Cosmelan programme.

This article provides general education and is not personalised medical advice.

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