What Is the Best Treatment for Melasma? Creams, Peels, Lasers and Tranexamic Acid Compared

Melasma causes patches and spots, usually on the face, that are darker than the person's natural skin tone; what it looks like and what triggers it are covered in our guide to melasma treatments.

This page compares the treatment categories.

The first difficulty: melasma cannot be cured.

Treatments can fade it, but it can come back, commonly after unprotected sun exposure, and the AAD describes a seasonal pattern many people see: it darkens in summer and fades in winter.

A 2022 systematic review added a second: recurrence remains high across all treatment types, so no category has solved the come-back problem.

Third, the triggers keep working against the plan.

The American Academy of Dermatology (AAD) lists possible melasma triggers that include sunlight, pregnancy hormones, some medications, stress (which it flags as controversial), tanning beds and thyroid disease.

And skin tone raises the stakes: the AAD warns that some melasma treatments can irritate darker skin, which can worsen and darken melasma, and that results usually take longer in darker skin tones.

Every category below sits on the same base: sun protection plus topical medication, the combination the AAD says is often the most effective.

For sunscreen, the AAD advises a daily broad-spectrum, water-resistant sunscreen of SPF 30 or higher that is also tinted and contains iron oxide, because visible light can worsen melasma, especially in darker skin tones.

Indoor tanning works against the plan: the AAD says tanning beds and sunlamps can worsen melasma and prevent treatment from working.

The topicals the AAD lists for melasma are prescription: hydroquinone, tretinoin plus a mild corticosteroid, and triple combination cream — tretinoin, a corticosteroid and hydroquinone in one cream — with gentler options that include azelaic acid, kojic acid and vitamin C.

Hydroquinone is no longer sold in non-prescription products in the US, so the best-studied options start with a prescriber.

The ranking evidence favors that base: a 2020 evidence-based review of 113 controlled trials with 6,897 participants concluded hydroquinone alone and triple combination cream are the most effective, best-studied melasma treatments, while chemical peels and laser- and light-based therapies were equal or inferior to topicals, with a higher risk of adverse effects.

Starting with a non-prescription product instead?

The AAD advises using it no longer than 3 to 6 months and seeing a dermatologist if results are not satisfactory.

Procedures enter when the base is not enough.

The AAD lists chemical peels, microneedling, laser and light treatments and PRP as add-ons for melasma, and says only a board-certified dermatologist should perform them — a professional recommendation from a dermatology society, not a legal rule.

In the ranking above, peels did not beat the topical base: the same review found chemical peels equal or inferior to topicals, with a higher risk of adverse effects.

The AAD's darker-skin caution weighs here too: some melasma treatments can irritate darker skin, which can worsen and darken melasma.

Peels treat melasma among several pigment and texture concerns, which is why they stay on the menu.

How types, strength and recovery compare is covered in our chemical peel guide, and our vi peel page looks at one specific system; the studies our research captured rank the category, not brands.

Start with the rule that covers every device below: no laser, peel or light treatment cures melasma or removes it permanently.

What lasers have been tested to do is reduce melasma scores.

A 2022 meta-analysis of 22 laser studies with 694 patients found reductions for low-fluence Q-switched Nd:YAG, fractional CO2 and fractional Er:YAG lasers, while picosecond lasers and a non-ablative 1550-nm fractional laser did not reach a significant reduction.

Our pico laser guide covers the picosecond devices and their clearances; the evidence above is what the meta-analysis measured.

What about Clear + Brilliant or the Moxi laser?

We found no direct melasma studies of either branded device in the research we reviewed — and Clear + Brilliant's own Important Safety Information says a person diagnosed with, or possibly having, melasma may not be an appropriate candidate for it.

Both devices are covered on our clear and brilliant and moxi laser pages.

IPL — a light treatment rather than a laser, covered in our ipl photofacial guide — is often said to make melasma worse, and the evidence is more mixed.

A 2020 meta-analysis of 8 studies with 215 patients found IPL-based combination therapy reduced MASI scores, the severity measure the melasma studies use.

But IPL carries a documented pigment risk: in a reported series of 675 Chinese patients with skin types III to IV treated with IPL, 2.96% developed melasma-like hyperpigmentation within 3 months — mostly people with prior pigment problems or poor sun protection.

So IPL is a risk to weigh, not a device that worsens melasma in everyone who has it.

Tranexamic acid (TXA) is the add-on dermatologists consider when other treatments fail, used as a pill — usually twice a day — or applied to the skin; the AAD says the prescribing doctor should ask about any history of blood clots first.

The evidence is recent: a 2024 meta-analysis of 22 randomized trials with 1,280 patients found TXA — oral, topical or injected — reduced melasma severity, with the oral form showing the largest reduction in MASI scores.

Side effects in those trials included stomach upset, skin irritation and menstrual irregularities, and the review notes long-term effects need more study.

The status line matters more than the marketing: oral tranexamic acid tablets are FDA-approved only for cyclic heavy menstrual bleeding, so melasma use is off-label — not on any current US label for the product — and requires a prescription.

In the melasma studies we reviewed, microneedling appears as a delivery partner for topical depigmenting agents such as TXA rather than as a stand-alone treatment.

A 2022 systematic review of 12 small studies found non-aggressive microneedling combined with topical depigmenting agents more effective than the topicals alone, with few side effects reported — but the evidence base is pilot trials, case series and split-face comparisons, which the review itself describes as small and mostly low-quality.

Microneedling is also on the AAD's add-on list.

How sessions are spaced and priced is covered in our microneedling guide.

If the categories have a verdict, it is the 2022 systematic review's: combination therapies, in double or triple combinations, yielded the best results compared with single therapies — even though recurrence stayed high in every group.

That matches the AAD's framing of a plan: sun protection, plus topical medication, plus a procedure for some people.

Maintenance is not optional, because the faded state is not permanent: melasma commonly comes back after unprotected sun exposure, which is what makes continued sun protection the plan's floor.

Two timing notes.

Results take months — following a plan, the AAD's range is 3 to 12 months, longer for long-standing melasma.

And melasma that first appears in pregnancy is on a different schedule: the AAD advises waiting until after the baby is born to treat it, partly because it may fade after delivery.

Budgeting is mostly out of pocket: the AAD notes most insurers will not cover melasma treatment because it is not considered medically necessary.

What drives the price of a melasma plan — the device, the number of sessions, the prescriptions — and what to ask a practice is on our melasma treatment page.

Melasma narrows the "near me" search before it starts, because the evidence puts prescription topicals first and the AAD recommends a dermatologist for the procedures it lists.

Three questions do most of the vetting: who performs the procedure, and with what certification; how the plan handles pigment risk in your skin tone; and whether it includes sun protection and a topical base rather than starting with a device.

A practice that leads with a laser package and skips the sunscreen-and-topicals base is out of step with the ranking evidence on this page.

Our melasma treatment guide covers the provider questions and what drives price in depth, and our concerns index maps other problems to the treatments that address them.

A local consultation answers the rest: who would treat you, what it costs there, and how they plan for skin like yours.