Understanding Melasma Treatments

Melasma is a skin conition that is characterized by hyperpigmented spots on the skin. Melasma is sometimes referred to as chloasma. The spots are most frequently found on the face and can vary in color from barely visible light-brown spots to more visible dark brown spots, and in some cases, the spots can show up in a blue-gray tone. There are several treatment options available to help reduce the appearance of dark spots.

Share This Post

Melasma is a skin condition that is characterized by hyperpigmented spots on the skin. Melasma is sometimes referred to as chloasma.

The spots are most frequently found on the face and can vary in color from barely visible light-brown spots to more visible dark brown spots, and in some cases, the spots can show up in a blue-gray tone.

There are several treatment options available to help reduce the appearance of dark spots.

Protection from Ultraviolet Light

There is no cure from melasma, but there are small changes that can help minimize the chances of aggravating melasma.

Studies have shown that ultraviolet (UV) light from the sun can aggravate melasma. Visible light sources including the exposure to fluorescent light bulbs and digital screens such as cell phones, computers, or even flat screen TVs can also exacerbate melasma.

In order to minimize exposure to UV and visible light, people with melasma should apply broad spectrum sunscreen with an SPF of 30 or higher as a part of their daily morning routine and reapply the sunscreen every two hours.

Sunscreens that contain iron oxide can improve the Melasma Activity and Severity Index (MASI) scores. Sunscreens with titanium oxide and zinc oxide can also provide protection for patients with melasma but may leave a visible layer of lotion on people with darker skin.

Wide-brimmed hats, baseball caps, and bucket hats can also help protect against UV light.

Topical Medications

There are several topical medications that can help speed up the fading of the melasma spots.

The majority of clinically-proven topical therapies require a dermatologist’s prescription.

Below are some of the topical medications that have been clinically proven to help treat melasma.

Tyrosinase Inhibitors

Tyrosinase is the enzyme responsible for melanogenesis, which is the process of producing pigment melanin in the skin.

In lay terms, tyrosinase gives color to the skin and inhibiting tyrosinase can stop the patches from developing. A comprehensive review of the therapeutics that have been shown treat melasma includes the following tyrosinase inhibitors:

  • Azelaic acid – Treatment with azelaic acid 20% showed significant improvement in MASI scores during the 24 weeks of treatment.
  • Hydroquinone – Daily treatment with hydroquinone 4% is the gold standard for topical skin lightening. This is typically the first line of therapy for people with melasma.
  • Kojic acid – A 12 week clinical study comparing the daily application of 0.75% kojic acid cream to 4% hydroquinone in 60 patients with melasma found that both treatment groups saw significant improvement of the MASI scores after 8 weeks of treatment. However, patients who were treated with 4% hydroquinone had overall better results compared to patients treated with kojic acid.
  • Licorice – A clinical study of 20 women with melasma found that the daily application of topical liquiritin 20% twice a day for 4 weeks led to improvement of melasma in 70% of the patients.
  • Mequinol – A small clinical study of 5 men with melasma who were treated with mequinol 2% and tretinoin 0.01% showed that four out of five patients had complete clearance at 12 weeks of treatment.
  • 4-N-Nutylresorcinol (4NBR) – Eight weeks of twice daily treatment with 4-n-Butylresorcinol 0.1% cream or vehicle showed significant improvement in 60% of patients. These results were part of a split-face study of 23 patients with melasma

It is important to note that some of these clinical studies include a small number of patients. 

Other topical medications that have shown to be effective therapies for treating melasma include tretinoin and corticosteroids.

Always consult a dermatologist to consider which treatment option would work best for you. It is especially important to consult a healthcare professional before beginning any treatment when the melasma is caused by pregnancy to ensure the medication is safe to use during pregnancy.

Systemic Treatments

The most popular systemic treatment for people with melasma is oral tranexamic acid.

The dosage typically varies from 500-750 mg daily but may be lower when used in combination therapies.

Several studies have validated oral tranexamic acid use for the treatment of melasma, with some clinical studies showing a response rate of up to 89.7% of patients treated with oral tranexamic acid.

Treatment with oral tranexamic acid can cause some serious side effects including thromboembolic events. Some of the more common side effects include gastrointestinal issues, headaches, and menstrual irregularities.

Methimazole is an oral antithyroid compound that is applied topically. About 70% of patients treated daily with methimazole 5% cream were satisfied with the results of the 12-week treatment in a study of 30 Egyptian patients with melasma.

Several studies have shown that methimazole may not be as effective for the treatment of melasma as treatment with hydroquinone 4% but may be better tolerated.

Combination Therapies 

Some medications work best when combined to reduce the appearance of melasma. Using a combination therapy of 250 mg of oral tranexamic acid taken daily in combination with the topical application of the liposomal form of azelaic acid 20% provided a 66.9% improvement in MASI scores of the patients treated with both medications.

The study compared the treatment with liposomal azelaic acid 20% and oral tranexamic acid to a combination treatment of hydroquinone 4% with oral tranexamic acid.

Both treatment groups saw improvement in the MASI scores and in overall quality of life. The group that used the azelaic acid 20% and 250 mg oral tranexamic acid saw the best results.

The triple combination cream, Tri-Luma; fluocinolone acetonide 0.01%, HQ 4%, tretinoin 0.05%, is the only FDA-approved melasma treatment with 3 active ingredients.

The three-ingredient combination cream includes a corticosteroid, a retinol, and a Tyrosinase inhibitor and is intended for short-term use in people with melasma. Women who are pregnant or trying to become pregnant should not use the cream.

In-Office Treatment Procedures

There are some minor in-office treatment procedures that can help reduce the appearance of melasma:

  • A chemical peel involves using a chemical agent to burn the skin. Some of the common peeling agents include trichloroacetic acid, glycolic acid, salicylic acid tretinoin, and Jessner’s solution. Chemical peels are effective for reducing the appearance of spots but are also considered a second-line agent. In some people, chemical peels may aggravate melasma. 
  • A microdermabrasion is a procedure that gently exfoliates the skin by using sand or a different type of small crystal to resurface the skin. Microdermabrasion has been shown to be a safe and effective treatment to help reduce the appearance of melasma. 
  • A typical third-line treatment option for melasma is laser therapy. Laser therapy, or laser resurfacing, requires the use of a laser at a specific wavelength to target the epidermal and dermal layers of the skin. Laser therapy options include Q-switch laser, picosecond lasers, non-ablative fractionated resurfacing lasers, and ablated fractionated resurfacing lasers. Laser therapies have shown to be effective treatments for patients that do not see improvement after using topical creams or other second-line treatments such as chemical peels, or microdermabrasion. Laser therapies can cause melasma rebound in some patients.  
  • Intense pulsed light (IPL) is a type of light therapy that has been shown to be helpful for patients with moderate to severe melasma. IPL can be used to treat larger areas of the face. While IPL is effective, it can lead to the development of other hyperpigmentation skin conditions or leave a crust on the skin that lasts up to 2 weeks after the treatment. 

There is no cure for melasma but there are several treatment options that can help reduce the appearance of melasma.

It is important to meet with a dermatologist to discuss which treatment options are most beneficial for your specific needs.

Women who are pregnant or planning to become pregnant should discuss their pregnancy plans with their doctor as several of the treatment options are not safe to use during pregnancy or for women who are nursing.

Some women who developed melasma spots during pregnancy may notice that the spots fade after pregnancy. 

Several of the clinical studies mentioned in this article show that while some treatment options work well for some patients, they can also exacerbate melasma in others.

Some patients may see that melasma spots fade on their own by regularly using sunscreen and limiting sun exposure. Always seek advice from a medical professional before beginning any treatment. 

References, Studies and sources:

  1. Melasma – Cleveland Clinic
  2. Huerth KA, Hassan S, Callender VD. Therapeutic Insights in Melasma and Hyperpigmentation Management. J Drugs Dermatol. 2019;18(8):718-729.
  3. Zolghadri S, Bahrami A, Hassan Khan MT, et al. A comprehensive review on tyrosinase inhibitors. J Enzyme Inhib Med Chem. 2019;34(1):279-309. doi:10.1080/14756366.2018.1545767
  4. Akl EM. Liposomal azelaic acid 20% cream vs hydroquinone 4% cream as adjuvant to oral tranexamic acid in melasma: a comparative study [published online ahead of print, 2021 Apr 7]. J Dermatolog Treat. 2021;1-6. doi:10.1080/09546634.2021.1905765
  5. Monteiro RC, Kishore BN, Bhat RM, Sukumar D, Martis J, Ganesh HK. A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma. Indian J Dermatol. 2013;58(2):157. doi:10.4103/0019-5154.108070
  6. Amer M, Metwalli M. Topical liquiritin improves melasma. Int J Dermatol. 2000;39(4):299-301. doi:10.1046/j.1365-4362.2000.00943.
  7. Keeling J, Cardona L, Benitez A, Epstein R, Rendon M. Mequinol 2%/tretinoin 0.01% topical solution for the treatment of melasma in men: a case series and review of the literature. Cutis. 2008;81(2):179-183.
  8. Huh SY, Shin JW, Na JI, Huh CH, Youn SW, Park KC. Efficacy and safety of liposome-encapsulated 4-n-butylresorcinol 0.1% cream for the treatment of melasma: a randomized controlled split-face trial. J Dermatol. 2010;37(4):311-315. doi:10.1111/j.1346-8138.2010.00787.x
  9. Rajanala S, Maymone MBC, Vashi NA. Melasma pathogenesis: a review of the latest research, pathological findings, and investigational therapies. Dermatol Online J. 2019;25(10):13030/qt47b7r28c. Published 2019 Oct 15.
  10. Farag A, Hammam M, Alnaidany N, et al. Methimazole in the Treatment of Melasma: A Clinical and Dermascopic Study. J Clin Aesthet Dermatol. 2021;14(2):14-20.
Sesame Care

Find the best price for great doctors and specialists

  • Thousands of doctors and specialists
  • $13,000,000+ saved by patients
  • 95% patient satisfaction
  • 4.3 on TrustPilot

Popular Destinations



Telehealth Reviews


Pharmacist Membership

About Us

Pharmacy Near Me

Recent Articles

Stress Acne: Causes, Prevention, and Treatment

Stress. It's a powerful emotion that can wreak havoc on your body. One way that stress can appear is on your skin in the form of stress acne. Stress causes acne by increasing oil production and clogging pores, which leads to an overgrowth of bacteria. To combat this unwanted side effect of stress, we have created a guide with everything you need to know about stress acne: its causes, prevention strategies, and treatments.

Read More »

Share On:

Subscribe To Our Newsletter

Get updates and learn from the best

More To Explore

Stress Acne: Causes, Prevention, and Treatment

Stress. It's a powerful emotion that can wreak havoc on your body. One way that stress can appear is on your skin in the

Cystic Acne: What Is It, And How Do You Treat It?

Cystic acne is a type of acne that causes cysts to form deep in the skin. These cysts are often painful and may take

A Guide to Anti Aging Cream for Men

It is frequently said that men are like fine wine – they get better with age. And while in general, men may seem to

Is Clindamycin Right for You as an Acne Treatment?

Clindamycin is an antibiotic that was first developed in 1966. It treats bacterial infections as well as acne, also called acne vulgaris. There are

Fordyce Spots, A Mystery Revealed

Fordyce spots, also called Fordyce granules, are small yellowish-white bumps that appear on the shaft of the penis, labia majora or labia minora, scrotum,

Clearing Up Butt Acne: Treatment, Prevention and More

Red bumps that appear like acne on the buttocks can occur in both men and women and is a common skin condition. Continue reading

How Much Does Accutane Cost?

What is Accutane | Used to Treat | How Does it Work | Cost | Side Effects If you’re one of the 50 million Americans who experiences acne annually, you’re no stranger

Your Comparison Guide of Minocycline vs Doxycycline

Minocycline and Doxycycline are both second-generation tetracycline-class antibiotics. They both are approved by the Food and Drug Administration (FDA) and have been proven effective for the treatment of acne, also known as acne vulgaris, but what else is

How to Diagnose and Treat Tinea Versicolor

Tinea versicolor is a common skin infection that causes red, scaly patches on the chest, back, or neck. You may also see flaky white

10 Best Ways to Help Prevent and Remove Blackheads

Blackheads develop when sebum from oil glands gets trapped in hair follicles or pores. Bacteria build up after time, so removing blackheads is important

What Is Minocycline?

Minocycline is a second-generation antibiotic in the tetracycline class of antibiotics. Second-generation, in this case, means that it is a semi-synthetic compound; first-generation tetracyclines are naturally

What is Accutane?

What is Accutane and can it really be used to treat acne? Read our latest blog for more details!

The Difference Between Tretinoin, Retinol, and Retinoids

Topical treatments like tretinoin, retinol, and retinoids for acne and wrinkles can be a little confusing to understand what each one is and what

What is Melasma and How Do You Treat It?

Melasma, sometimes referred to as chloasma, is a skin disorder characterized by darker spots on the skin. The patches can vary in color

A Comprehensive Guide to Minocycline for Acne

If you suffer from acne, there is a targeted medication for treating acne–minocycline. Minocycline is a prescription drug used to treat infections by preventing

Tretinoin Strengths and How They Work With Acne

Tretinoin is a topical medication that is used for the treatment of acne, also called acne vulgaris, and the most common brand in the

How to Get Rid of Hyperpigmentation

Hyperpigmentation, or dark spots on the skin, can be tricky to get rid of. If you are dealing with this condition, you are not

How to Deal with Blood Blisters

Blood blisters are a medical condition where fluid-filled bubbles grow out of blood vessels in the skin. They form under the skin and can

Geologie Review: Does This Personalized Men’s Skincare Work?

Geologie offers personalized skin care products tailored to each male customer they have. The personal touch is certainly nice, but do their products really

Everyday Tips for Anti-Aging Skin Care

With so many anti-aging products available on the market, it is overwhelming to find which products actually work and are worth spending money on