Concern hub · Pigmentation

Melasma in South Asian skin.

Why those brown patches keep coming back, what genuinely helps, and how to treat melasma safely in brown skin, explained by a dermatology doctor.

Reviewed by Dr. Khadija Farid, FCPS Dermatology Resident 13 references Last reviewed: 23 October 2026

Chronic

Melasma is long-term and often relapses, even after successful treatment.⁵⁶

Light + heat

Ultraviolet and visible light, heat and hormones all drive it.¹⁴

Types IV–V

Pakistani and Indian skin usually falls in Fitzpatrick types IV–V, where pigment problems are common.¹²

Control

The realistic goal is long-term control: lighter patches and fewer flares.⁶

What melasma is

Melasma causes symmetrical brown or grey-brown patches, most often on the cheeks, forehead, bridge of the nose, upper lip and chin. It is not dangerous or contagious, but it can deeply affect confidence and quality of life.⁴

Pigment cells in melasma are over-active. Research now shows the deeper skin is involved too, with sun-damage changes, extra blood vessels and a weakened basement membrane. This is why treating only the surface pigment often leads to relapse.⁵

Common triggers

Sunlight, including visible light from the sun, which ordinary untinted sunscreens do not block well.¹
Heat: kitchens, ovens, saunas and hot weather.
Hormones: pregnancy, contraceptive pills and hormone treatment.
Irritating skincare and harsh home remedies that inflame the skin.
Genetics: it often runs in families.

Is it really melasma?

Several conditions look similar in brown skin but need different treatment. A dermatologist can tell them apart, sometimes with a Wood’s lamp or dermoscope.⁶

Post-inflammatory hyperpigmentation: dark marks after acne, eczema or injury.
Hori’s naevus: grey-blue spots on the cheeks.
Lichen planus pigmentosus: slate-grey patches, often on the face and neck.

Exogenous ochronosis: blue-black darkening from long-term unsupervised hydroquinone.¹¹
Steroid-damaged skin: redness, thinning and acne after using steroid “fairness” creams.
Drug-induced pigmentation from some medicines.

See a dermatologist promptly if a patch is raised, bleeding, itchy, changing quickly, only on one side, or appeared after a new medicine.

How melasma is treated

The treatment ladder

Combination treatment works better than any single option, and every step sits on top of daily protection.⁷

Step 1 · Everyone

Protect

Daily broad-spectrum sunscreen, ideally a tinted one with iron oxides to block visible light, reapplied through the day, plus shade and a hat.¹³

Step 2 · Most people

Treat the surface

Lightening creams such as azelaic acid, topical tranexamic acid, vitamin C or, under a doctor, hydroquinone or triple-combination cream.⁷¹¹

Step 3 · Selected patients

Treat from inside

Oral tranexamic acid is a prescription medicine with good evidence. A doctor must first check your clot risk and other medicines.⁸⁹

Step 4 · Specialist

Procedures

Peels, carefully chosen lasers or microneedling can help stubborn melasma, but in brown skin they carry a real risk of rebound darkening if done badly.⁴⁶

Evidence at a glance

What works, and how sure are we?

Evidence levels follow our editorial standards. They describe the research, not a promise for any one person.

Treatment	What it does	Evidence	In brown skin
Broad-spectrum sunscreen (tinted)	Blocks UV; iron oxides also block visible light	Strong	Essential for everyone; choose a tint that matches¹²³
Triple-combination cream	Hydroquinone + tretinoin + mild steroid	Strong	Short, supervised courses only; contains a steroid⁷¹¹
Hydroquinone	Blocks pigment production	Strong	Use under a doctor; long unsupervised use can cause ochronosis¹¹
Oral tranexamic acid	Reduces pigment signalling and blood-vessel factors	Moderate	Prescription only, after screening for clot risk⁸⁹¹⁰
Topical tranexamic acid	Same pathway, applied to skin	Moderate	Generally well tolerated⁸
Azelaic acid	Calms pigment cells and inflammation	Moderate	Gentle option; can sting at first⁷
Vitamin C	Antioxidant and mild lightening	Limited	Slow, modest effect; small studies¹³
Chemical peels	Remove surface pigment	Moderate	Superficial peels preferred; risk of dark marks⁶
Lasers and IPL	Break up pigment	Moderate	Results often short-lived; rebound risk if settings are wrong⁶⁷

A simple melasma routine

Morning

Gentle cleanser
Antioxidant serum, such as vitamin C (optional)
Moisturiser
Tinted broad-spectrum sunscreen, SPF 30 or higher; reapply every 2–3 hours outdoors

Evening

Gentle cleanser
Your treatment cream, as advised by your doctor
Moisturiser

Introduce one new active at a time, and stop anything that stings or reddens persistently.

Myths that make melasma worse

“Lemon, toothpaste and home remedies fade it”

They irritate the skin, and irritation in brown skin creates more pigment, not less.

“A laser will cure it for good”

Lasers can lighten melasma, but relapse is common without ongoing protection and maintenance.⁶

“Sunscreen is only for sunny days”

Visible light and daylight reach your skin indoors near windows and on cloudy days.¹

A warning for Pakistan

Unregulated “fairness” and “melasma” creams, often sold without a prescription, may contain strong steroids, hydroquinone or mercury. They can work quickly at first and then cause steroid-damaged skin: redness, thinning, acne, visible vessels and worse pigmentation. If a cream works “too fast”, stop and see a dermatologist. Check your cream for warning signs →

Frequently asked questions

Melasma: your questions answered

Can melasma be cured permanently?

Melasma is a long-term condition that often relapses, especially with sun, heat and hormonal changes. Treatment can lighten it a great deal, and daily sun protection with maintenance treatment keeps it under control.

What is the best sunscreen for melasma?

A broad-spectrum sunscreen of SPF 30 or higher, ideally tinted with iron oxides, because visible light also worsens melasma. Reapply every 2 to 3 hours when outdoors.

Is tranexamic acid good for melasma?

Studies support tranexamic acid for melasma, both as a cream and as a prescription tablet. Tablets are a medicine with safety checks, including clot risk, so they must only be taken under a doctor.

Is hydroquinone safe for melasma?

Hydroquinone is effective when used under a doctor for limited periods. Long, unsupervised use, often through unregulated fairness creams, can cause permanent blue-black darkening called ochronosis.

Can lasers remove melasma?

Lasers can lighten melasma, but results are often temporary and brown skin carries a risk of rebound darkening if the device or settings are wrong. They are usually a later option, combined with creams and sun protection.

Why does melasma come back in summer?

Ultraviolet light, visible light and heat all re-activate pigment cells. Summer brings more of all three, which is why protection matters most in the hottest months.

What treatment is safe for melasma in pregnancy?

Daily tinted mineral sunscreen is the safest step. Azelaic acid is a common doctor-advised option. Hydroquinone, retinoids and tranexamic acid tablets are usually avoided in pregnancy.

References

Lyons AB, et al. Photoprotection beyond ultraviolet radiation: a review of tinted sunscreens. J Am Acad Dermatol. 2021;84(5):1393–1397. doi:10.1016/j.jaad.2020.04.079
Abdel Azim S, et al. Sunscreens part 1: mechanisms and efficacy. J Am Acad Dermatol. 2025;92(4):677–686. doi:10.1016/j.jaad.2024.02.065
Draelos ZD, et al. International consensus on anti-aging dermocosmetics and skin care. J Drugs Dermatol. 2024;23(1):1337–1343. doi:10.36849/JDD.7798
Gan C, Rodrigues M. An update on new and existing treatments for the management of melasma. Am J Clin Dermatol. 2024;25(5):717–733. doi:10.1007/s40257-024-00863-2
Jo JY, et al. Update on melasma treatments. Ann Dermatol. 2024;36(3):125–134. doi:10.5021/ad.23.133
Neagu N, et al. Melasma treatment: a systematic review. J Dermatolog Treat. 2022;33(4):1816–1837. doi:10.1080/09546634.2021.1914313
Liu Y, et al. Comparison of the efficacy of melasma treatments: a network meta-analysis of randomized controlled trials. Front Med. 2021;8:713554. doi:10.3389/fmed.2021.713554
Calacattawi R, et al. Tranexamic acid for melasma: meta-analysis and systematic review of RCTs. J Dermatolog Treat. 2024;35(1):2361106. doi:10.1080/09546634.2024.2361106
Wang WJ, et al. The optimal dose of oral tranexamic acid in melasma: a network meta-analysis. Indian J Dermatol Venereol Leprol. 2023;89(2):189–194. doi:10.25259/IJDVL_530_2021
Basit A, Rahman A, Uddin R. Oral tranexamic acid with triple combination cream versus triple combination cream alone in melasma (randomised trial, Lahore). J Ayub Med Coll Abbottabad. 2021;33(2):293–298. PMID 34137548
Sofen B, Prado G, Emer J. Melasma and post-inflammatory hyperpigmentation: management update and expert opinion. Skin Therapy Lett. 2016;21(1):1–7. PMID 27224897
Chan IL, et al. Characteristics and management of Asian skin. Int J Dermatol. 2019;58(2):131–143. doi:10.1111/ijd.14153
Correia G, Magina S. Efficacy of topical vitamin C in melasma and photoaging: a systematic review. J Cosmet Dermatol. 2023;22(7):1938–1945. doi:10.1111/jocd.15748

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