Melasma Treatment Options: What Dermatologists Consider

Sources: AAD, FDA, MedlinePlus (see Sources).

A dermatologist can often diagnose melasma by looking at your face and neck. The AAD says a Wood's lamp or dermatoscope helps show how deep the pigment reaches, which shapes treatment, and a small skin biopsy may be done if it could be another condition. Melasma typically appears as symmetrical brown patches on the cheeks, forehead, nose or upper lip (MedlinePlus). For what triggers it, see What Causes Melasma?.

Melasma is linked to sun exposure, pregnancy, hormonal medicines such as birth control pills and hormone therapy, and stress (AAD; MedlinePlus). MedlinePlus notes it often fades over several months after a pregnancy ends or hormone medicines are stopped, and can return with a later pregnancy or renewed use. Don't stop a prescribed medicine on your own; ask the prescribing doctor about alternatives.

Sunlight makes the skin produce more pigment, which darkens existing melasma and causes new patches. The AAD advises:

• Broad-spectrum, water-resistant sunscreen, SPF 30 or higher, applied 15 minutes before going out and reapplied at least every two hours.
• Tinted sunscreen with iron oxide, because visible light can worsen melasma, especially in darker skin tones. Sunscreens with zinc oxide or titanium dioxide are often recommended.
• A wide-brimmed hat, UV-protective sunglasses and shade.
• No tanning beds or sunlamps, which can worsen melasma and keep treatment from working.

Without this step, other treatments tend to fail.

Most patients receive a prescription medicine to apply at home (AAD):

• Hydroquinone. A common melasma treatment that evens skin tone. Since the CARES Act took effect, FDA says over-the-counter skin-lightening products with hydroquinone are unapproved and can't be legally sold; the AAD says it is no longer available without a prescription. FDA has warned that some illegally sold OTC products can cause harm, including ochronosis (a bluish-black skin discoloration) that may be permanent.
• Triple-combination cream. Hydroquinone, tretinoin and a corticosteroid together. FDA says Tri-Luma is currently the only FDA-approved drug containing hydroquinone, a prescription product approved for "short-term treatment of dark spots associated with moderate-to-severe melasma of the face," to be used under a clinician's supervision.
• Tretinoin with a mild corticosteroid.
• Gentler options: azelaic acid, kojic acid or vitamin C, often for sensitive skin.

The AAD recommends applying products in this order: melasma medicine, then sunscreen, then camouflage makeup. Choose gentle, fragrance-free skin care; products that burn or sting can irritate skin and darken spots.

When creams and sun protection aren't enough, the AAD lists add-on procedures:

• Chemical peel, to help remove excess pigment. See What Is a Chemical Peel?.
• Microneedling, which tends to heal with more even tone.
• Laser and light treatments. The AAD says a few studies found that adding them improved results for patients already using medicine and sun protection. Settings matter; ask how your dermatologist adjusts for your skin type. See What Is Fraxel Laser?.
• Platelet-rich plasma (PRP), plasma from your own blood injected into the affected skin.

The AAD says only a board-certified dermatologist should perform these procedures for melasma.

For melasma that resists other treatment, the AAD says a dermatologist may discuss tranexamic acid, applied to the skin or, more often, taken as a pill twice a day, usually alongside the triple-combination cream, sun protection and iron-oxide makeup. In studies it reduced melasma patches when other treatments failed.

Two FDA facts matter here. Oral tranexamic acid (Lysteda) is FDA-approved for cyclic heavy menstrual bleeding, so prescribing it for melasma is off-label. Its label lists contraindications including combined hormonal contraception and active or past blood clots or an intrinsic clotting risk. The AAD says to tell your dermatologist if you've had a blood clot.

• Timeline: usually 3 to 12 months, longer for long-standing melasma (AAD).
• Recurrence: common with sun exposure or hormonal changes (MedlinePlus).
• Maintenance: year-round sun protection and, often, a maintenance cream.
• Camouflage: tinted sunscreen or makeup can even tone while treatment works.
• Cost and insurance: the AAD notes melasma treatment usually isn't considered medically necessary, so most insurers don't cover it. Ask about costs before starting.

• Is this melasma, and how deep is the pigment?
• What's my sun- and visible-light-protection plan?
• Which prescription cream do you recommend, for how long, and what are the side effects?
• If I need a procedure, which one, and how do you adjust it for my skin tone?
• Am I a candidate for tranexamic acid given my medical history and contraception?
• What's the maintenance plan once my skin clears?
• Is anything different if I'm pregnant, planning a pregnancy or breastfeeding?

• Get a diagnosis from a board-certified dermatologist.
• List your medicines, including hormonal ones, and any history of blood clots.
• Buy a broad-spectrum, tinted SPF 30+ sunscreen with iron oxide.
• Avoid unregulated lightening creams sold online.
• Plan for at least three months before judging results.

Browse Dermatologists in the Haute MD Network.

Featured doctors: Dr. Anna Chacon, a board-certified dermatologist and founder of Miami Derm, a medical, surgical and cosmetic dermatology practice in Miami, whose profile lists melasma among the skin concerns she treats, and Dr. S. Manjula Jegasothy, a board-certified cosmetic dermatologist and founder and medical director of the Miami Skin Institute in Coral Gables, Florida, whose listed treatments include Fraxel, Vbeam and medical-grade skincare.

• What Causes Melasma?
• What Is Melasma?
• How Is Hyperpigmentation Treated?
• What Is a Chemical Peel?
• What Is Fraxel Laser?

• American Academy of Dermatology, "Melasma: Diagnosis and treatment" — https://www.aad.org/public/diseases/a-z/melasma-treatment (diagnosis, creams, procedures, tranexamic acid, 3–12 month timeline, insurance; checked Nov. 12, 2026)
• American Academy of Dermatology, "Melasma: Self-care" — https://www.aad.org/public/diseases/a-z/melasma-self-care (sunscreen, iron oxide, tanning beds, gentle skin care; checked Nov. 12, 2026)
• MedlinePlus (NIH/NLM), "Melasma" — https://medlineplus.gov/ency/article/000836.htm (causes, Wood's lamp, outlook; checked Nov. 12, 2026)
• U.S. FDA, "FDA works to protect consumers from potentially harmful OTC skin lightening products" — https://www.fda.gov/drugs/drug-safety-communications/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products (CARES Act status of OTC hydroquinone, ochronosis, Tri-Luma; page content current 05/01/2026; checked Nov. 12, 2026)
• U.S. FDA / DailyMed, LYSTEDA (tranexamic acid) tablets prescribing information — https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a7e3180d-cf5b-4c2c-a31f-68bf6181f19a (indication and contraindications; checked Nov. 12, 2026)

This guide is general information, not medical advice. Treatments and results vary; talk with a board-certified dermatologist about your skin and health history.