Short answer
Melasma is usually treated with strict daily sun protection plus prescription lightening creams, most often hydroquinone alone or in a “triple combination” cream with tretinoin and a mild steroid. Tranexamic acid, chemical peels and some laser or light treatments may be added when creams are not enough, but procedures can also worsen pigmentation. Melasma can be lightened but often returns, so treatment depends on its triggers, how deep the pigment lies and the person’s skin tone.
Key points
- Melasma is common, harmless and not a form of skin cancer.
- Sun and visible light, hormones and genetics are the main drivers.
- Sun protection is the foundation of every treatment plan.
- Results usually take 3 to 12 months.
- Peels and lasers can cause new darkening, especially in darker skin.
What melasma is and what drives it
Melasma causes flat, brown or grey-brown patches, mostly on the cheeks, forehead, chin and above the upper lip. It affects women far more than men and is most likely in people with medium to dark skin tones.2 Around 90% of cases are in women, and it usually starts between the ages of 20 and 40.3
Triggers include ultraviolet and visible light, heat, the hormones oestrogen and progesterone (in pregnancy, contraceptive pills and hormone therapy), some medicines and irritating skin products. A third to a half of people with melasma report a relative with it.3 Because other conditions can look similar, the American Academy of Dermatology (AAD) advises confirmation by a dermatologist before treatment.2
Pigment can sit in the surface layer of skin, the deeper layer, or both. Pigment in the deeper layer takes longer to fade, and treatment plans take into account both skin tone and how deep the pigment lies.31
The treatment options
| Option | Role | Main caution |
|---|---|---|
| Sun protection | Foundation of all treatment and of preventing relapse1 | Must be daily and continued long term |
| Hydroquinone, or triple combination cream | Usual first prescription treatment1 | Needs a prescription |
| Azelaic acid, kojic acid, vitamin C | Alternatives or additions1 | Results vary between people |
| Tranexamic acid | Cream or tablets when other treatments fail1 | Health review needed; history of blood clots matters |
| Peels, lasers, light treatments | Add-on for stubborn melasma3 | Can cause new darkening or scarring |
Sun protection
Dermatologists recommend a broad-spectrum sunscreen of SPF 30 or higher, a wide-brimmed hat and shade, often favouring sunscreens containing zinc oxide, titanium dioxide or iron oxide; tinted versions can avoid a white cast.1 Visible light and heat also play a part in melasma, not only ultraviolet light.3 Consistent sun protection also helps prevent melasma returning after treatment.1
Creams
Hydroquinone is a common prescription lightening agent. It may be combined with tretinoin (a vitamin A cream) and a mild corticosteroid as a triple combination cream.1 Cleveland Clinic describes this three-part combination as the best-reported option.3 Azelaic acid, kojic acid and vitamin C are alternatives.1
Tranexamic acid
Tranexamic acid can be applied to the skin, injected or taken as tablets, and is used when other treatments have not worked.13 Before prescribing it, a dermatologist reviews the person’s health first, including any history of blood clots.1
Peels, lasers and light
Chemical peels, microneedling, laser and light treatments are used for melasma, and the AAD advises that only a dermatologist should perform them.1 They can cause post-procedure darkening (hyperpigmentation) and raised scars.3 Pigment changes after peels and lasers are more common, and may be permanent, in brown or Black skin.45 For melasma, which itself is most common in darker skin, this risk weighs heavily.
What to expect from treatment
Results usually take 3 to 12 months, and longer for long-standing melasma.1 Melasma may fade on its own after a trigger ends, such as after childbirth or stopping a medicine, and often fades within about three months of pregnancy, but it is unlikely to fade while pregnancy or hormonal contraception continues.13
Relapse is common. Melasma can last for years and come back after successful treatment, which is why daily sun protection continues after the patches have lightened.2 The AAD suggests that people who are pregnant wait until after delivery before treating it, and that non-prescription products be used for no more than three to six months before seeing a dermatologist.2
Common questions
Can melasma be cured permanently?
Not reliably; treatments can lighten it, but it may return, especially with sun exposure or hormonal triggers.2
Is melasma dangerous?
No; it cannot harm the body and is not a form or sign of skin cancer, though a dermatologist should confirm the diagnosis.12
Will a laser remove melasma?
Lasers can lighten melasma in some people but can also cause new darkening and scarring, so they should be done only by experienced specialists.3 See what laser skin resurfacing is.
Does contraception matter?
It can; hormonal contraception is a recognised trigger, and non-hormonal contraception is one way to reduce it.3
Bottom line
Melasma is managed rather than cured: daily sun protection and prescription creams do most of the work, with tranexamic acid and procedures kept for stubborn cases. Procedures can backfire in darker skin, and relapse is common, so patience and long-term protection matter as much as any single treatment.
Related reading
- Medical aesthetics overview
- How Do Chemical Peels Work, and Which Depth Is Which?
- What Is Laser Skin Resurfacing?
- What Are Skin Boosters?
Sources
- American Academy of Dermatology. Melasma: Diagnosis and treatment. AAD. https://www.aad.org/public/diseases/a-z/melasma-treatment. Accessed 5 November 2026.
- American Academy of Dermatology. Melasma: Overview. AAD. https://www.aad.org/public/diseases/a-z/melasma-overview. Accessed 5 November 2026.
- Cleveland Clinic. Melasma: Treatment, Causes and Prevention. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21454-melasma. Accessed 5 November 2026.
- Mayo Clinic. Chemical peel. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/chemical-peel/about/pac-20393473. Accessed 5 November 2026.
- Mayo Clinic. Laser resurfacing. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/tests-procedures/laser-resurfacing/about/pac-20385114. Accessed 5 November 2026.
Article history
- — First published.