Laser Treatment for Melasma and Dark Marks: Help or Harm?

Ashley Harwyn, PA-C, ABAAHP  |  Published October 24, 2025  |  Last updated October 6, 2026  |  21 min read

Lasers can lighten melasma and dark marks, and they can also make them worse. Here is how to tell the two apart, why a cream-first plan comes first, and what darker skin needs before any laser.

This guide explains why. Melasma and post-inflammatory hyperpigmentation (PIH) both react badly to irritation, and a review of laser and light studies found that common devices can lighten melasma but that it tends to come back, and some devices leave new dark or light patches behind.[6] Below you will find how to tell the two apart, what goes wrong when a laser is used too early, what a cream-first plan includes, and the extra care darker skin needs. For how we sort every kind of dark spot at a visit, see our hyperpigmentation treatment page.

• Melasma and PIH are different conditions with different triggers, and neither is the same as a sun spot, so naming the problem comes before choosing a treatment.[2][4]
• Lasers and light devices can lighten melasma, yet recurrence is high and some devices raise the risk of new dark or light patches, which is why one review ranks them as a third-line option.[6]
• The first line for melasma is sun protection plus prescription or gentler fading creams, and the AAD says results usually take 3 to 12 months.[1]
• A tinted sunscreen with iron oxide matters because visible light worsens melasma, and in one randomized trial it improved results over a UV-only sunscreen.[3][8]
• PIH fades best when the cause, such as acne, is controlled first, and a mark a few shades darker than your skin usually fades within 6 to 12 months.[4][5]
• Darker skin tones get melasma and PIH more often, and several lasers carry more risk on deeper skin, so device choice and preparation matter more than speed.[2][5][6]

Is it melasma, a dark mark from acne, or something else?

Melasma is a pattern of gray-brown patches, usually on the face, that appears when the pigment-making cells in your skin, called melanocytes, become overactive.[2] A Cochrane review describes it as symmetrical, with patches that typically run together on the face.[7] The AAD lists sunlight, pregnancy, birth control pills, anti-seizure medicines, drugs that make skin sun-sensitive, tanning beds, and thyroid disease among possible triggers, and notes that the role of stress is still debated.[2] It is much more common in women than in men, women between 20 and 40 carry a higher risk, and in one study of 324 people with melasma, 48% reported having a blood relative with it.[2]

PIH is different. It is darkening that follows inflammation or injury to the skin, and it shows up in the same place as the original problem.[5] The AAD notes that dark spots like these often appear after a pimple or patch of psoriasis clears, or after an insect bite, cut, burn, or other injury heals, and that certain medicines, an irritating skin or hair product, and hormonal changes such as pregnancy can also bring them on.[4] So the pattern is often a clue. PIH sits where the injury was, while melasma tends to show up as matching patches on both sides of the face.[5][7]

Depth matters as much as type. A review of PIH in skin of color explains that pigment in the top layer of skin looks tan to dark brown and can take months to years to fade without treatment, while pigment deeper in the skin looks blue-gray and may be permanent or fade only very slowly.[5] Melasma is also sorted by depth, into epidermal, dermal, mixed, and indeterminate types.[6] Dermatologists may use a Wood's lamp or a dermatoscope to see how deep the pigment goes, and sometimes a small biopsy to rule out a look-alike.[1]

There is a third look-alike: the sun spot, or solar lentigo. Sun spots follow different rules and call for a different plan, so they have their own guide on laser treatment for sun spots. If you cannot tell which one you have, that is normal. The AAD notes that melasma can look like other skin conditions, which is why a close exam comes before any plan.[1]

Why can a laser make melasma or dark marks worse?

Pigment lasers and IPL devices work by aiming light at pigment so it can be destroyed while the surrounding skin is spared.[6] That is the whole idea, and it is also the problem, because your normal skin holds pigment too. The 2017 review notes that IPL on darker skin carries an elevated risk of hitting that normal pigment.[6] The review of PIH in skin of color warns that laser energy aimed at deeper targets can be soaked up by a well-pigmented top layer of skin instead, leading to discoloration, blistering, and scars.[5] The same review stresses using caution with every one of these treatments to prevent irritation and worsening of PIH.[5]

Melasma adds a second layer of trouble. Its pigment cells are already overactive,[2] and the 2017 review lists inflammation among the factors implicated in causing it.[6] The 2017 review of laser and light therapy found that intense pulsed light (IPL), low-energy Q-switched lasers, and nonablative fractional lasers all appear to lighten melasma, but recurrence over time is high, and some techniques raise the risk of new dark or light patches.[6] It flagged ablative fractional lasers as carrying a very high risk of both, and found vascular lasers do not appear to work for melasma at all.[6]

One trial in that review shows how this plays out. Twenty-two people with skin types III to V had one side of the face treated with a low-energy Q-switched laser plus 2% hydroquinone, and the other side with hydroquinone alone. The laser side lightened more at first. But three patients, all with type V skin, developed mottled light patches, eight developed confetti-like light spots, and three months after treatment, four had rebound darkening and the melasma had come back in every patient.[6] In another study described in the review, half of the patients with darker skin developed PIH after a vascular laser combined with a triple cream.[6]

“Rebound” is the word to remember. It means pigment flaring back after a procedure. The review advises that anyone considering laser for melasma be told plainly about the chances of recurrence, PIH, and rebound darkening before treatment.[6]

What does a cream-first plan for melasma include?

The review of laser and light therapy lays out the usual order. Treatment typically starts with managing risk factors, strict UV protection, and topical lightening creams, which it calls the current first-line treatment. Chemical peels are second-line, and lasers and light come third.[6] The AAD puts it in similar terms: there is no single best treatment, and the most effective plan often combines sun protection with medicines you apply at home, sometimes with a procedure added.[1]

Step 1: Sun protection, every day. The AAD recommends a broad-spectrum, water-resistant sunscreen with SPF 30 or more, applied 15 minutes before you go out and reapplied at least every two hours, along with shade, a wide-brimmed hat, and sunglasses.[3] It also advises staying out of tanning beds, which can worsen melasma and keep treatment from working.[3] For melasma, dermatologists often suggest sunscreens with zinc oxide, titanium dioxide, or iron oxide.[1]

Step 2: Block visible light too. Visible light has been shown to worsen melasma, especially in darker skin, so the AAD suggests a tinted sunscreen that contains iron oxide.[3] A randomized, double-blind trial in Mexico tested this directly. All 68 patients used 4% hydroquinone for 8 weeks. One group got a sunscreen with iron oxide and the other got a UV-only sunscreen, both rated SPF 50 or higher. Of the 61 who finished, the iron oxide group improved 15% more on a melasma severity score and 28% more on a skin color measure.[8] It was a small, short trial, but it fits what the AAD advises.

Step 3: A fading cream chosen for your skin. The AAD lists hydroquinone, a tretinoin and mild corticosteroid combination, and a triple combination cream that pairs tretinoin, a corticosteroid, and hydroquinone, with azelaic acid, kojic acid, or vitamin C as gentler choices.[1] A Cochrane review gathered 20 randomized studies with 2,125 participants. Triple combination cream lightened melasma more than hydroquinone alone, and 20% azelaic acid beat 2% hydroquinone but not 4% hydroquinone. The side effects reported most often were mild and short-lived, such as irritation, itching, burning, and stinging.[7] The authors also judged the overall quality of the studies to be generally poor, so no cream comes with a guarantee.[7]

Hydroquinone deserves a word of its own. Under the CARES Act, starting September 23, 2020, over-the-counter skin lighteners without FDA approval had to come off the market, and the FDA says there are no legally marketed over-the-counter skin lightening products.[10] The FDA names Tri-Luma, a prescription cream for the short-term treatment of dark spots from moderate-to-severe melasma, as the only FDA-approved drug containing hydroquinone.[10] The FDA has also received reports of rashes, facial swelling, and ochronosis, a skin discoloration that may be permanent, from hydroquinone lighteners.[10]

That is why hydroquinone belongs under a clinician's eye. We carry the ZO Skin Health line. Its 4% hydroquinone creams are prescription products that, as our ZO page explains, have not been through FDA approval, and we fit ZO products to your skin at a visit rather than handing them over off a shelf.

Step 4: For stubborn cases, ask about tranexamic acid. When melasma is very hard to treat, the AAD says a dermatologist may add tranexamic acid, usually as a pill taken twice a day, and will ask about any history of blood clots first.[1] In a placebo-controlled trial that enrolled 44 patients with moderate-to-severe melasma, 250 mg twice daily for 3 months, plus sunscreen, cut severity scores by 49%, compared with 18% on placebo. Three months after stopping, the gains had narrowed to 26% versus 19%, and no serious side effects were seen.[9] The trial was small, done at one center, and mostly enrolled Hispanic women, so it is a promising result, not a settled one.[9]

Then comes the hard part: patience. The AAD says that when you follow the plan, results usually take 3 to 12 months, and longer if you have had melasma for a long time.[1] Melasma can also fade on its own once a trigger such as pregnancy or a medicine is gone.[1]

How do you fade dark marks left behind by acne?

With PIH, the first job is to stop making new marks. The review of PIH in skin of color advises starting treatment early and beginning with the condition that caused the inflammation in the first place.[5] For acne marks, that means getting breakouts under control with proper acne treatment, because, as the AAD notes, dark spots often appear as a pimple clears.[4]

Next come fading ingredients and sun care. The same review lists topical lightening agents plus daily sunscreen as typical first-line therapy, and names hydroquinone, azelaic acid, kojic acid, arbutin, retinoids, vitamin C (ascorbic acid), and niacinamide among the options.[5] The AAD's list for darker skin tones includes azelaic acid, glycolic acid, kojic acid, a retinoid, and vitamin C, with a tinted sunscreen containing iron oxide because visible light also causes dark spots.[4] The AAD adds that you should stop any product that burns or stings and never use liquid bleach on your skin.[4]

Expect a slow fade. The AAD says that once the cause is found and stopped, a spot a few shades darker than your natural skin color usually fades within 6 to 12 months, while deep color can take years.[4] Chemical peels and lasers can help marks that do not respond to creams, but the PIH review stresses using caution with every one of these treatments, since irritation can make PIH worse.[5]

If a procedure does make sense, a chemical peel chosen for your skin tone is one option we may talk through. Still, the review notes that topical therapy is typically effective for PIH in the top layer of skin.[5] Our post on why customized skin care matters explains why a plan built around your own skin type, concerns, and goals matters.

Is laser treatment safe for darker skin tones?

It can be, but darker skin leaves less room for error: people with darker skin are more likely to have melasma or PIH, and several devices carry more risk on deeper skin. The AAD says melasma is more common in medium and dark skin tones, and more likely in women of Latin, Asian, Black, or Native American heritage.[2] PIH also affects darker skin more often and more severely, and one study cited in the PIH review found discoloration problems to be the second most common diagnosis among African American patients.[5]

Clinicians describe skin with the Fitzpatrick scale, numbered from type I to type VI. The 2017 review groups types I to III as lighter-colored skin and types IV to VI as darker skin, and that number shapes device choice.[6] The 2017 review found IPL best suited to types I to III, because on darker skin it is more likely to hit normal pigment, and it said IPL and Q-switched lasers should only be used on types I to III for melasma.[6] Nonablative fractional lasers were the exception it described, as able to treat a wider range, types III to VI.[6]

Some clinicians try a small test spot first. The review suggests that when IPL or Q-switched lasers are used on darker skin, test spots at the edge of the affected area, done several weeks ahead, may be warranted. It also notes real debate about whether a test spot reliably predicts how the full treatment will go.[6] So a clean test spot is not a guarantee.

Your own history is another guide. Solcara's hyperpigmentation page describes taking a thorough history first, because past dark marks from bug bites, waxing, burns, or earlier treatments show how your skin tends to react. If that history suggests a laser or light session is likely to cause more marks than it clears, the page says we will say so and build the plan around topicals, sun protection, and gentler procedures instead. Sun care carries extra weight here, since the AAD notes that visible light worsens melasma, especially in people with darker skin tones.[3]

Had a laser or peel leave you darker than before? Call 843-981-0870. Bring notes on what was done and how your skin reacted. That history helps your clinician sort out whether you are looking at melasma, PIH, or both.

If a laser is on the table, how should it be done?

There is a real place for lasers in melasma care. The AAD notes that a few studies have found adding a laser or light treatment can improve results for patients who are already applying medicine to their skin and protecting it from the sun.[1] The key word is adding. The 2017 review says laser and light therapy suits melasma that has not responded to creams or a series of chemical peels, and that people should be told about the likelihood of recurrence, PIH, and rebound darkening before they start.[6]

The same review describes how to stack the odds in your favor. If you are not already on a lightening cream, it recommends starting one at least two to six weeks before the procedure.[6] After treatment, it calls for continuing lightening creams, and it found that a long-term maintenance plan is needed to slow recurrence and limit rebound darkening or PIH.[6] It also reports that nonablative fractional lasers may give slightly longer remissions than other options, while Q-switched lasers need the most sessions to show a benefit.[6]

If you are considering a laser for pigment anywhere, these are fair questions to ask first:

• Which condition do you think I have, melasma, PIH, sun spots, or a mix, and how did you decide?
• Which device would you use, and how does it suit my skin type?
• Should I use a lightening cream before treatment, and for how long?
• Would you do a test spot, and what would it tell us?
• What is the plan if my pigment rebounds or new light spots appear?
• What maintenance will I need afterward, and for how long?

A plain answer can include “a laser is not your best option right now.” For a sense of how a laser appointment and its aftercare unfold, see our guide to what to expect from your first laser treatment, and our laser services page lists the treatments we offer.

Planning pigment care in Charleston and Mount Pleasant

At Solcara, care is led by Ashley Harwyn, PA-C, who is board certified in anti-aging and functional medicine through A4M (ABAAHP). Our hyperpigmentation page describes the first visit as a skin evaluation: your clinician looks at each spot, asks about sun exposure, hormones, medicines, and skin history, and sorts out which type of pigment you have. Any spot that needs a dermatologist's exam is referred before anything is treated.

For melasma, the hyperpigmentation page describes a cream-first approach, or a mix that adds a chemical peel or medical-grade home care, and your skin history helps decide whether light or laser belongs in the plan at all. Expect ongoing upkeep rather than a one-time fix, because sun protection helps keep melasma from returning and recurrence after procedures is common.[1][6] Individual results vary, and we will tell you if a treatment is unlikely to help.

Solcara sees patients at our Mount Pleasant office at 496 Bramson Ct, Ste 120, and at The Longevity Club, 163 Rutledge Ave, Ste 202, in downtown Charleston. You can book a skin visit online or call 843-981-0870.

Ashley Harwyn, PA-C PA-C, ABAAHP · Founder, Solcara Health Online

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