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Melasma Treatment ProtocolPigmentation from sun exposure, hormones and predisposition

The key treatment steps for melasma — with consistent sun protection as the foundation of every further therapy.

In short: Melasma are brownish patches on the face caused mainly by sunlight, hormones (e.g. pregnancy, the contraceptive pill) and sometimes a genetic predisposition. Treatment requires patience, as the patches usually fade only slowly. The most important building block is consistent sun protection — without it, no other therapy works in the long term.

What is melasma?

Melasma are brownish patches on the face caused mainly by sunlight, hormones (for example pregnancy or the contraceptive pill) and sometimes a genetic predisposition. Treatment requires patience, as the patches usually fade only slowly.

The most important building block of treatment is consistent sun protection — without it, no other therapy works in the long term.

Treatment steps

1. Sun protection — the most important measure

  • Apply a sunscreen with a high protection factor (SPF 30–50+) daily, even on cloudy days and even indoors near a window.
  • A tinted sunscreen containing iron oxide is best. Iron oxide additionally protects against visible light (e.g. from screens and lamps), which can also worsen melasma.
  • Apply sunscreen generously and several times a day, especially when spending time outdoors.
  • A wide-brimmed hat or sunglasses also help.

2. Daily skincare

  • Use mild, non-irritating cleansing products to avoid further irritating the skin.
  • Active ingredients such as niacinamide, vitamin C, kojic acid or arbutin can be used as supportive care, especially during breaks between stronger treatments.
  • Avoid aggressive peels or at-home products without medical guidance, as they can worsen the patches.

3. Pigment-reducing creams

  • The most effective cream is a triple-combination cream (hydroquinone, tretinoin, a corticosteroid), prescribed by a dermatologist. It is usually applied in cycles, with breaks in between.
  • Azelaic acid is a good alternative if the combination cream is not well tolerated.
  • In more severe or persistent cases, a tablet (tranexamic acid) may additionally be prescribed. This is not suitable for all patients (for example, not with an increased risk of thrombosis, when planning pregnancy, or when taking the contraceptive pill at the same time).

4. Chemical peeling

A chemical peel (for example with fruit acid or trichloroacetic acid) can further lighten the pigmented patches. It is performed at the practice and should be combined with cream treatment, as it is usually not sufficient on its own.

5. Laser treatment

Laser is used only when creams and peels do not work sufficiently, since laser can also worsen melasma if used incorrectly.

  • The erbium fibre laser (a gentle, fractionated laser) has the best evidence among lasers as a stand-alone treatment for persistent melasma.
  • Other lasers (e.g. erbium:YAG laser) are usually used only in combination with a cream.
  • Particularly strict sun protection is necessary after every laser treatment, as the skin is temporarily more sensitive.

Melasma cannot be cured, but it can be well controlled with consistent sun protection, individualised cream therapy and patience.

Important to know

  • Treating melasma usually takes several months.
  • Even after successful treatment, the patches can return, especially with sun exposure or hormonal changes — which is why lasting sun protection is essential.
  • All creams, tablets and laser treatments should only be started after medical consultation.

Sources

  1. Clinical basis of this treatment protocol: treatment description provided by Dr. med. Paul Georg.
  2. Sarkar R, Desai SR, Sinha S, et al., Delphi consensus on melasma management by international experts and Pigmentary Disorders Society, Journal of the European Academy of Dermatology and Venereology (2026).
  3. Kwon SH, Na JI, Choi JY, Park KC, Melasma: Updates and perspectives, Experimental Dermatology (2019).
  4. Yao H, Shen S, Gao X, et al., Definition of refractory melasma and its treatment: a review, Lasers in Medical Science (2024).
  5. Gan C, Rodrigues M., An Update on New and Existing Treatments for the Management of Melasma, American Journal of Clinical Dermatology (2024).
  6. Morgado-Carrasco D, Piquero-Casals J, Granger C, Trullàs C, Passeron T, Melasma: The need for tailored photoprotection to improve clinical outcomes, Photodermatology, Photoimmunology & Photomedicine (2022).
  7. Kundu RV, Riley JM, et al., Managing Facial Hyperpigmentation, JAMA Dermatology (2023).
  8. Ghasemiyeh P, Haghighi NF, Dastgheib L, Ranjbar S, Mohammadi-Samani S, Safety and efficacy of niosomal and conventional tranexamic acid/niacinamide vs. hydroquinone creams in melasma: a randomized, double-blind, case-controlled clinical trial, Scientific Reports (2025).
  9. Four further sources named by the user (on trichloroacetic-acid peeling and erbium-laser combination studies) could not be confirmed as findable during this research and are therefore not listed here.

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Dermetrics — Dr. med. Paul Georg

Board-certified specialist in Dermatology and Venereology · Clinic Selnau · Partner practice MediX Altstetten

This page provides general patient information and does not replace individual medical advice.