The pigment of melasma develops gradually and resolution is also gradual. Resistant cases or recurrences occur often and are certain if strict avoidance of sunlight is not rigidly heeded. All wavelengths of sunlight, including the visible spectrum, are capable of inducing melasma. The precise manner in which these modalities can be used has not been fully delineated. However in some experienced hands they have anecdotally been reported to be safe, effective, and produce results much quicker than topical medications.
More careful study is needed before they can be recommended as a standard treatment.
In an attempt to hasten resolution many practitioners attempt mild exfoliation with superficial chemical peels. The rational is that if melanogenesis is inhibited with bleaching agents and keratinocyte turnover is increased the time to resolution can be reduced. A number of studies have shown that treating melasma with superficial chemical peels and a bleaching agent is safe and effective. There is debate as to whether superficial chemical peels actually hasten the resolution of pigment versus bleaching agents alone. Studies comparing bleaching agents alone to the combination of bleaching agents and superficial chemical peels are ongoing and may help to resolve the debate.