Melasma is a chronic condition, not just dark patches
Melasma shows up as brown to grey-brown patches on the cheeks, forehead, and upper lip, and it behaves differently from sun spots or freckles. It is driven by hormones, UV, and heat, which is why it flares in the Singapore sun and after pregnancy or the contraceptive pill. Evidence-based reviews describe it as an acquired, chronic pigmentary disorder that tends to recur. The honest goal is long-term control, not a one-off removal.
What causes melasma, and why sunscreen alone often falls short
If your patches darken even though you wear sunscreen every day, you are not doing it wrong. Melasma grows out of several triggers stacking up on skin that is already prone to it, and a standard sunscreen only covers part of the problem.
Ultraviolet light is the trigger everyone knows. Visible light, the ordinary brightness of daylight, is the one most people miss. In a study of volunteers with medium to dark skin, visible light produced darker and longer-lasting pigment than long-wave UVA, while fair skin showed none. Local conditions raise the stakes: the National Environment Agency notes that the UV index commonly reaches Very High and Extreme levels between 11 am and 3 pm on days with little cloud.
Hormones and genes decide who is prone. In a survey of 324 women treated for melasma across nine clinics, 48% had a relative with it, 42% first noticed it after a pregnancy, and a quarter of those who had used hormonal contraception said it first appeared after they started.
A case-control study of 207 women with melasma and 207 without found a family history in 61% of the women with melasma, against 13% of the women without.
Biopsies add one more piece. Skin with melasma carries more long-term sun damage beneath the pigment than the skin beside it, which has led researchers to propose that melasma is a photoaging disorder in people who are genetically prone to it. It helps explain why patches return after the surface clears: the damaged layer underneath is still there.
Melasma or another kind of pigmentation?
Not every brown patch is melasma. Sun spots sit on sun-exposed skin as small, defined dots; freckles darken with sun and fade without it; post-inflammatory pigmentation is the stain a breakout or injury leaves behind. Melasma is different: soft-edged, symmetrical patches, usually across both cheeks, the forehead, or the upper lip.
The distinction decides the plan. Other pigmentation types generally tolerate more direct laser work, while melasma calls for restraint. Marks left behind by acne follow their own path, covered on our acne scar treatment page. If you are not sure which you have, a Wood's lamp assessment is the tool we use to help tell them apart.
The three types of melasma, and why pigment depth changes the plan
If your melasma fades on the surface and keeps coming back, the depth of the pigment may be part of the reason. Melasma is sorted two ways, by where it shows and by how deep the pigment sits. The original classification described three patterns: across the centre of the face, over the cheeks, and along the jawline. In a Singapore study of 205 patients at a tertiary skin referral centre, 89% had it over the cheeks, more than two in three had the shallower epidermal type, and most waited around five years before seeking treatment.
Depth matters because deeper pigment is harder to reach. Clearance is often incomplete and relapse frequent, probably because treatments struggle to clear pigment in the deeper layer. A Wood's lamp helps estimate the depth, but it is a guide, not a verdict: when researchers examined melasma under the microscope, every one of the 21 patients studied had extra pigment in both layers. A careful plan uses the lamp to start, then lets your skin's response steer the next step.
If your patches turn out not to be melasma at all, our guide to pigmentation treatment walks through sun spots, freckles and acne marks.
Why the wrong melasma treatment can make it worse
Melasma is the pigmentation type where doing more can set you back. In Asian and darker skin, lasers are second-line to topical creams because of variable response and a real risk of complications. Aggressive, high-energy settings can sensitise the pigment cells and trigger rebound darkening, sometimes worse than where you started. The research is clear that the answer is low fluence and restraint, not a stronger laser.
What melasma treatment should start with, per the evidence
Reviews consistently put topical treatment and strict sun protection ahead of any device. For melasma that keeps returning, oral tranexamic acid is a well-supported addition: a meta-analysis of randomised trials found it meaningfully reduces melasma severity with a strong safety record, and in Asian skin even low doses over eight to twelve weeks help. Dr Samantha builds this foundation before considering a laser.
Melasma treatment options compared, from creams and tablets to lasers
Most people reading this have already tried something, and the section above set the order: topicals first, tranexamic acid next, laser last. Here is how strong the trial evidence is behind that order, option by option, and what each one risks if it goes wrong. A review of 113 trials with 6,897 participants found more trial support for prescription lightening creams than for any other option, while peels and lasers performed the same or worse on their own and carried more side effects. Combining treatments tends to beat any single one: in a network analysis of 59 trials, 27 of the 31 studies that compared them favoured a combination.
Which of these suit you, and which you have already tried, is what the assessment sorts out. The sections below show what the trials found for each group.
What the prescription creams can and cannot do
In an Asian trial of 242 patients, 64.2% of those using the triple cream reached no or mild melasma at eight weeks, against 39.4% on hydroquinone alone, though more had mild irritation.
Gentler options hold their own. 20% azelaic acid matched 4% hydroquinone in a 24-week trial of 329 women, and 4% niacinamide gave good to excellent improvement in 44% of patients, against 55% with hydroquinone, with fewer side effects.
The limit is safety over time. A blue-grey staining called ochronosis has been linked mostly to hydroquinone above 4% or used for longer than three months, which is why it belongs in supervised courses.
What oral tranexamic acid showed in Singapore patients
Oral tranexamic acid is well studied in local patients. In a Singapore study of 561 patients treated for a median of four months, 89.7% improved, 10.0% saw no change and 0.4% worsened, and those who improved did so within two months.
The gains do not always last: 27.2% of those who improved later relapsed, and one patient developed a blood clot linked to an inherited clotting disorder, which is why screening comes first. A smaller Singapore study of 25 stubborn cases found severity scores fell by 69% on average when the tablet was added to creams. These are results from published studies, not a promise of what you will see; individual response varies.
Where peels, microneedling and supplements fit in
Procedures earn their place as helpers to a cream, not replacements for one. A systematic review of 24 peel studies found glycolic acid peels performed well with few side effects, and adding microneedling to a lightening serum improved results further by 12 to 16 weeks across 12 studies of 459 patients. An oral fern extract, Polypodium leucotomos, sped up early improvement alongside cream and sunscreen in a 40-patient pilot trial at Singapore's National Skin Centre, though both groups had improved by the end.
When laser treatment is right for melasma, gentle beats aggressive
Used carefully, low-fluence picosecond laser has been shown to be effective with a low complication rate in Asian skin, but it responds better to a paced, maintained approach than to one aggressive course. At Nexus this is the gentle Pico Glow toning on our Pico laser, chosen by depth rather than by power.
How Dr Samantha approaches melasma treatment at Nexus
She maps your pigment under a Wood's lamp first, to read whether it is epidermal, dermal, or mixed, and calms an active flare before any laser. When a laser is appropriate she keeps it gentle, paced, and maintained. If a past treatment went wrong, bring photos. The fix is almost never a stronger laser, it is the right protocol at the right depth. When laser is the right call, she tackles it with Pico laser treatment, matched to your pigment depth.
What a melasma treatment course at Nexus looks like
Every course starts the same way: Wood's lamp mapping, a review of what has been tried before, and screening before any tablet is considered. The first weeks belong to the foundation, daily SPF 50, a topical routine matched to your skin, and, where appropriate, oral tranexamic acid over the eight-to-twelve-week window the Asian-skin studies support.
Laser, when it earns its place, enters later and gently: short, low-fluence Pico Glow sessions spaced weeks apart, with the response reviewed before each next step. Flares are calmed first through the topical routine and screening pathway, and laser is reserved until the flare has settled.
The course does not really end. Because melasma is chronic, the final stage is a maintenance rhythm, sun discipline, periodic reviews, and a plan for flare months, so the aim is keeping the condition under control over the long term.
How long melasma treatment takes to show a difference
Expect weeks, not days. Trials usually judge a cream at eight weeks and microneedling at 12 weeks or more. What happens next depends on maintenance: in a randomised trial of oral tranexamic acid, severity scores fell 49% after three months on treatment, but three months after stopping, the gain against the starting point had shrunk to 26%.
Melasma in pregnancy, and what is safe to use while you wait
Pregnancy is one of the most common starting points for melasma, often called the mask of pregnancy. In one study of 400 pregnant women, 15.8% had it, and reviews report higher rates in some groups, along with an uncomfortable fact: up to 30% of cases persist after delivery, some still visible ten years later, and it tends to return in later pregnancies. Time outdoors matters too. In the nine-clinic survey, every extra 10 hours a week working outside raised the odds of it starting during pregnancy by about 27%.
What you can use changes while you are pregnant or breastfeeding. Sun protection is the lowest-risk starting point, and a 2025 review recommends tinted, mineral-based sunscreens in pregnancy. Hydroquinone is usually held back because more of it is absorbed into the body than most skin products, and oral tranexamic acid is not used in pregnancy or while breastfeeding. Stronger treatment is a plan for after birth, made with your obstetrician.
- Pregnant
Protect
Daily sunscreen, shade in the midday hours and gentle skincare. Nothing stronger without your obstetrician's agreement.
- Breastfeeding
Stay gentle
Keep up sun protection, with only the creams your doctor has cleared for nursing.
- After weaning
Assess and plan
Map the pigment and build a plan, adding creams, tablets or gentle laser only where they are needed.
Melasma that lingers after pregnancy is common, and it can be treated once the timing is right.
Why melasma comes back, and how to keep it faint for longer
Relapse is common even after good treatment, which is why a Latin American expert consensus advises continuing a lightening cream and strict sun protection once melasma is under control. Keeping it faint is a routine, not a one-off.
The simplest change with strong evidence is the sunscreen itself. Standard broad-spectrum sunscreens do not block visible light well; tinted ones made with iron oxides do. In a randomised trial of 68 patients, adding visible-light protection gave 15% more improvement over eight weeks than UV-only sunscreen, and in a six-month relapse trial, melasma crept back less on the tinted formula.
Helps keep melasma faint
- A tinted SPF 50 sunscreen every morning, reapplied when you are outdoors
- Shade, a hat or an umbrella between 11 am and 3 pm
- A maintenance cream your doctor has matched to your skin
- A review before a planned pregnancy or a long stretch in the sun
Tends to set it back
- An untinted sunscreen applied once and forgotten
- Scrubs, strong peels or aggressive laser that inflame the skin
- Lightening creams bought online with unlisted ingredients
- Stopping everything the moment the patches fade
The aim is control you can live with, rather than a one-off clear.
Five melasma myths that keep people stuck in the same cycle
Will a stronger laser clear melasma faster?
The research points the other way. High-energy lasers carry an unacceptably high rate of rebound darkening in melasma, which is why low energy and a slow pace are the safer route.
Are phone and laptop screens causing your melasma?
A randomised study found that short-term exposure to blue light from electronic devices did not worsen melasma. Daylight is where your protection belongs.
Are whitening creams bought online a safe shortcut?
In May 2026 the Health Sciences Authority warned that whitening and anti-ageing products bought online contained mercury, a potent steroid, and the prescription ingredients hydroquinone and tretinoin, with one product more than 7,000 times over the mercury limit. Used without supervision, hydroquinone can also stain the skin blue-grey, and that staining is often hard to treat.
Will glutathione drips lighten melasma?
A 2025 systematic review advised against intravenous glutathione, citing a lack of effect and the risk of side effects. Creams and tablets with trial data behind them are a better use of your time and money.
Is melasma something only women get?
Men get it too. In the Singapore tranexamic acid study, 8.6% of the 561 patients were men, and in a study of 200 patients in India, 20.5% were. It looks and behaves the same way, with sun exposure and family history as the main drivers.
What melasma treatment costs, and what pushes the total up or down
There is no single price for melasma, because a plan is built from parts. What you spend depends on which parts you need, and on how long it takes to bring the patches under control.
Current Pico Glow prices are listed on our Pico laser treatment page, linked earlier in this guide. One thing to plan for: the CPF Board states that MediSave generally cannot be used for optional or cosmetic treatments, so check with your insurer before you start if cover matters to you.
Questions to ask your doctor before any melasma treatment starts
A good plan should hold up to a few direct questions. Bring these to any consultation, including ours.
- Is this definitely melasma, and how deep does the pigment look?
- What is likely driving mine: sun, hormones, family history, or a past treatment?
- What goes first, and what are we holding back until later?
- Am I suitable for tranexamic acid, and how will you screen me?
- If laser is part of the plan, what setting will you use, and how many weeks apart?
- How will we measure progress, and when do we review it?
- What does maintenance look like once the patches have faded?
See a doctor sooner, rather than treating at home, if a patch appears on one side of the face only, changes shape or colour quickly, bleeds or itches, or appeared after you started a new medicine. Melasma is usually symmetrical and quiet, so anything that behaves differently deserves a proper look.
Common questions about melasma
Melasma is a chronic condition, so the honest answer is that it is managed and kept faint rather than permanently removed. With the right plan and sun protection, most patients keep it well controlled.
Hormones, UV, and heat keep driving new pigment, and sun exposure is the main reason it returns. That is why daily sun protection and maintenance matter as much as the treatment itself.
Melasma usually appears as soft-edged, symmetrical patches on both cheeks, the forehead, or the upper lip. Sun spots and freckles are smaller and more defined, and post-inflammatory marks trace back to a breakout or injury. A Wood's lamp assessment helps tell them apart, and also shows how deep the pigment sits.
Yes. It is less common in men, but it looks and behaves the same way, with sun exposure and family history as the main drivers. Assessment and treatment follow the same approach.
Melasma is one type of hyperpigmentation. It stands apart through symmetrical patches on the face, a strong link to hormones and sunlight, and a habit of returning. Other hyperpigmentation, such as marks left by acne or injury, can appear anywhere and often responds to more direct treatment.
A randomised study found that short-term exposure to blue light from electronic devices did not worsen melasma. Daylight is the source to protect against, which is why a tinted sunscreen matters.
It can, if it is over-treated with aggressive settings. That is why Dr Samantha maps the pigment first and uses low-fluence Pico Glow, which has a low complication rate in Asian skin when kept gentle.
Yes. Randomised trials show oral tranexamic acid reduces melasma severity, and it is a well-supported addition for recurrent melasma after screening for any contraindications.
Gentle Pico Glow toning is designed for minimal downtime, which is one reason it suits working patients in Singapore. Your exact plan is set after the assessment.
The studies in Asian skin support low-dose courses over eight to twelve weeks, after screening. Whether it is right for you, and for how long, is decided at the assessment, not from a template.
Gently, yes. Daily sunscreen and gentle skincare are the lowest-risk starting point. Hydroquinone is usually held back and oral tranexamic acid is not used while pregnant or nursing, so stronger treatment waits until after birth or weaning. Plan it with your obstetrician.
Usually not. The CPF Board states that MediSave generally cannot be used for optional or cosmetic treatments. Private insurance rules vary, so check with your insurer before you start.
Expect weeks rather than days. Trials usually judge the response after two to three months of a steady plan. Because relapse is common, the plan then moves into maintenance instead of simply stopping.
Often yes. Bring photos to the consultation. The usual fix is to re-map your pigment and switch to a gentler protocol, rather than to use a stronger laser.
