What is melasma?
Melasma causes flat brown or grey-brown patches, usually on both sides of the face. It commonly affects the cheeks, forehead, nose and upper lip. Sun protection and carefully chosen topical treatment are the starting point; procedures are not necessary for everyone.
It is more common in women, but men can develop it too. Melasma usually does not hurt or itch, although its appearance can affect confidence.
Is it melasma, freckles or another dark mark?
| Skin concern | Typical appearance | Common contributors | Common locations |
|---|---|---|---|
| Melasma | Brown or grey-brown patches, often on both sides | Sunlight, hormones and inherited tendency | Cheeks, forehead and upper lip |
| Freckles | Small, separate spots that can darken in sunlight | Inherited tendency and sun exposure | Face, shoulders and arms |
| Post-inflammatory marks | Flat dark marks where acne, irritation or an injury has healed | Previous skin inflammation | Face or body |
“Dark spots” is a broad description, not one diagnosis. These conditions can overlap, so a photograph or the colour alone cannot reliably identify the cause.
What triggers melasma?
- Sunlight: UV exposure can darken melasma. Visible light also matters, particularly in darker skin tones.
- Hormones: Pregnancy and some hormonal medicines, including birth control pills, can trigger melasma in susceptible people.
- Family history: An inherited tendency makes some people more prone to it.
- Irritating skincare: Burning or stinging products can worsen dark marks. Scrubbing harder is not a treatment.
If you suspect a medicine is contributing, discuss it with the prescriber. Do not stop or change prescribed treatment yourself.
Can you tell whether melasma is superficial or deep?
Epidermal, dermal and mixed melasma describe where pigment is distributed in the skin. Colour alone does not establish its depth or mean you need a laser.
A dermatologist examines the patches and asks about their history and possible triggers. A Wood’s lamp or dermatoscope may help, but these tools have limits and do not replace clinical assessment.
Daily care for melasma in Thailand
- Protect against UV: Use a broad-spectrum, water-resistant sunscreen with SPF 30 or higher, plus shade and a wide-brimmed hat. Reapply about every two hours outdoors and after swimming or sweating, following the label.
- Add visible-light protection: Choose a tinted sunscreen containing iron oxides. This can support melasma care, but sunscreen alone will not clear every case.
- Keep skincare gentle: Use a mild cleanser and moisturizer. Pause cosmetic products that cause persistent burning, redness or peeling, and get advice if irritation does not settle.
Keep this routine during everyday outdoor travel as well as beach trips. Treatment cannot compensate for repeated unprotected sun exposure.
Which treatments can help?
Topical medicines
A doctor may recommend hydroquinone, azelaic acid or a combination cream containing hydroquinone, tretinoin and a mild corticosteroid. The choice and duration depend on your skin and medical history.
These medicines need follow-up. Irritation can make pigmentation worse. Hydroquinone can also cause a difficult-to-treat blue-black discolouration called ochronosis. Do not increase the strength or keep using a steroid-containing combination indefinitely.
Cosmetic brightening products have different evidence and formulations. Retinol and prescription retinoids are not interchangeable treatments.
Tranexamic acid
Tranexamic acid may be considered for selected patients. Topical products and tablets are different treatments with different risks. Oral tranexamic acid requires medical screening because of blood-clot risk. It should not be used by people with a history of blood clots or those using combined hormonal contraception. Do not start tablets yourself.
Peels, laser, light and RF treatments
A dermatologist may add a procedure when suitable, usually alongside sun protection and topical care. Irritation, burns and post-inflammatory pigmentation are possible, and melasma can recur or become darker. A treatment should not be chosen solely because the patches are described as “deep.”
RF microneedling delivers radiofrequency energy through needles; it is different from a laser. Ask about the exact device, evidence for your concern and risks. It is not a guaranteed solution for resistant melasma.
The U.S. FDA has reported serious complications with certain uses of RF microneedling, including scarring, fat loss and nerve injury.
After a procedure, follow the clinic’s specific aftercare instructions. Ask when to restart active skincare and sunscreen if the skin is broken. There is no single recovery time for every method.
What if you are pregnant or breastfeeding?
Avoid hydroquinone and retinoids during pregnancy. Retinoid medicines should also be avoided when planning pregnancy. Tell your clinician if you are pregnant, trying to conceive or breastfeeding before starting melasma medicines or elective procedures, so the plan can be reviewed.
Can melasma disappear permanently?
Some melasma fades after pregnancy or a change in its trigger; other cases last for years. Even after improvement, it may return. The aim is gradual fading and long-term control, not a promise of a permanent cure.
Improvement usually takes months, and no fixed number of sessions suits everyone. If treatment is not helping, review the diagnosis and plan rather than using stronger creams or booking more frequent procedures yourself.
When should you see a doctor?
Seek assessment if you are unsure what the patches are, they persist despite care, or they affect your confidence. A spot that changes size, shape or colour, becomes raised, bleeds, hurts or itches needs prompt examination before cosmetic treatment.
References
- American Academy of Dermatology. Melasma: Signs and symptoms and Causes.
- American Academy of Dermatology. Melasma: Diagnosis and treatment and Self-care.
- Castanedo-Cazares JP, et al. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. 2014.
- Del Rosario E, et al. Randomized, placebo-controlled, double-blind study of oral tranexamic acid in moderate-to-severe melasma. 2018.
- British Association of Dermatologists. Melasma. 2024. Navya A, Pai V. Comparison of Dermoscope and Woods Lamp as a Tool to Study Melanin Depth in Melasma. 2022. American Academy of Dermatology. Skin cancer: Symptoms, diagnosis and causes.
- DailyMed. TRI-LUMA prescribing information and tranexamic acid tablets prescribing information.
- American Academy of Dermatology. Dermatologist-approved pregnancy skin care. Medicines and Healthcare products Regulatory Agency. Pregnancy precautions for topical retinoids.
- U.S. Food and Drug Administration. Potential risks with certain uses of radiofrequency microneedling. 2025.
- Indian Association of Dermatologists, Venereologists and Leprologists. Freckles. American Academy of Dermatology. Acne scars and flat dark marks.