Melasma: What's the best treatment?

Melasma is a common skin condition that causes brown or greyish patches, usually on the face. It is more common in women but can occur in men also. It does not cause any physical symptoms. Although the exact cause not well known, it is often triggered by hormonal changes (especially in pregnancy), sun exposure, certain medications. It is more common in people of colour and if there is a family history of the condition. While melasma is not harmful, it can be difficult to treat. The best approach depends on the severity of the pigmentation and the patient’s skin type.

Young woman who has melasma, considering what the best treatment for it, is.

What are the most effective treatments for melasma?

Treatment for melasma focuses on reducing pigmentation and preventing it from worsening. The most effective options include:

Topical treatments

These should be prescribed and monitored by a dermatologist and given only for a limited period of time to minimise side effects and avoid worsening pigmentation with overuse.

Often the topical creams are used in combination to get the best results. Some of these are not safe to use in pregnancy.

Hydroquinone: A skin-lightening agent that reduces melanin production and is often the first-line treatment.
Retinoids: Help increase cell turnover, improving skin texture and lightening dark patches over time.
Corticosteroids: Sometimes combined with hydroquinone and retinoids in triple combination creams.
Azelaic acid: A milder alternative that inhibits pigment production and is safe for sensitive skin.
Other creams: vitamin C, kojic acid, cysteamine and thiamidol are also other creams which can be helpful in managing pigmentation

Chemical peels

Mild chemical peels using glycolic acid, salicylic acid, or trichloroacetic acid (TCA) can help remove pigmented skin cells and promote regeneration.
These should be performed by a dermatologist to minimise irritation and avoid worsening pigmentation.

Laser and light-based therapies

Laser treatments (such as Q-switched lasers and fractional laser therapy) target pigmentation without damaging surrounding skin. These treatments should be approached with caution, as improper use can lead to increased pigmentation.

Sun protection

Daily use of a Broad-spectrum mineral based sunscreen (SPF 50+) is essential for preventing melasma from developing and worsening.
Wearing wide-brimmed hats and sunglasses provides additional protection.

Oral treatments

Tranexamic acid: A prescription medication that helps reduce pigmentation from within.
Antioxidants and vitamins: Supplements like vitamin C and glutathione may support skin health.

Can melasma be cured permanently?

Melasma can be managed effectively, but it may not always disappear completely. Long-term maintenance with strict sun protection and skincare is crucial to prevent recurrence.

The best treatment for melasma varies for each individual. A combination of topical treatments, professional procedures, and strict sun protection offers the most effective results. Consulting a dermatologist is the best way to determine the right approach based on skin type and severity.