# What works for melasma and hyperpigmentation: sunscreen, skincare actives and prescription options URL: https://dermalguide.com/articles/what-works-for-melasma-and-hyperpigmentation/ Published: 2026-10-24 > Melasma needs daily tinted sunscreen first, then gentle actives such as azelaic acid, niacinamide and tranexamic acid. What the evidence says, and when to see a dermatologist. ## Short answer What works best for melasma is daily broad-spectrum sunscreen, ideally a tinted one with iron oxides, combined with a skin-lightening treatment. The best-studied treatments (hydroquinone, triple-combination cream and oral tranexamic acid) are prescription-only in the US. Azelaic acid, niacinamide, vitamin C and topical tranexamic acid are gentler options in skincare. Expect 3 to 12 months, and expect melasma to come back without sun protection. ## What this means for you ### Start with what you notice Fade brown or gray-brown patches on the cheeks, forehead or upper lip, and stop them coming back. ### The ingredient names, translated Melasma is a type of hyperpigmentation: skin making too much pigment in patches. Sunlight and visible light (the light you can see) both set it off, and hormones such as pregnancy or the pill often play a part. So the first job is blocking light every day with a sunscreen, preferably a tinted one. The pigment colors in tinted sunscreen, called iron oxides, help block visible light. The second job is a product that slows pigment production. The strongest of those need a prescription. ### How to decide - If the patches are even on both cheeks, the forehead or the upper lip, that pattern is typical of melasma. Start with a tinted sunscreen every morning and reapply when you're outdoors. - If you want a skincare active, pick one: azelaic acid, niacinamide, vitamin C or a tranexamic acid serum. Give it a few months before you judge it. - If the dark spots came after pimples or a rash rather than appearing in patches, that is post-inflammatory hyperpigmentation, which is different. See our acne marks guide. - If nothing has helped after a few months, or a spot looks different from the others, see a dermatologist. Hydroquinone, triple-combination cream and oral tranexamic acid all need a prescription. ### What to expect Melasma fades slowly, over months rather than weeks, and often returns with summer sun or heat. Lasers and strong peels can make it worse. Ingredient studies don't tell you how any finished product will work on your skin. General guidance, not a test of these products: [Melasma: diagnosis and treatment (American Academy of Dermatology)](https://www.aad.org/public/diseases/a-z/melasma-treatment); [Melasma: who gets it and causes (American Academy of Dermatology)](https://www.aad.org/public/diseases/a-z/melasma-causes); [Melasma (DermNet)](https://dermnetnz.org/topics/melasma); [FDA works to protect consumers from potentially harmful OTC skin lightening products (FDA)](https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products); [Castanedo-Cazares JP et al. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatol Photoimmunol Photomed. 2014 (PMID 24313385)](https://pubmed.ncbi.nlm.nih.gov/24313385/); [Kim HJ et al. Efficacy and safety of tranexamic acid in melasma: a meta-analysis and systematic review. Acta Derm Venereol. 2017 (PMID 28374042)](https://pubmed.ncbi.nlm.nih.gov/28374042/); [Rajaratnam R et al. Interventions for melasma. Cochrane Database Syst Rev. 2010 (PMID 20614435)](https://pubmed.ncbi.nlm.nih.gov/20614435/); [Navarrete-Solís J et al. A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatol Res Pract. 2011 (PMID 21822427)](https://pubmed.ncbi.nlm.nih.gov/21822427/). Each product's label source is linked on its product page. Melasma is frustrating because it seems to ignore effort. You buy a brightening serum, the patches lighten a little, then one beach weekend undoes it. That isn't a product failing. Melasma is driven by light and hormones, so a serum alone can't keep up with the trigger. This guide covers what the evidence supports, which skincare actives are worth trying, what a dermatologist can prescribe, and the habits that quietly make it worse. ## What is melasma, and how is it different from other dark spots? Melasma is a common type of **hyperpigmentation**, meaning skin that makes too much pigment (melanin) in places. [DermNet](https://dermnetnz.org/topics/melasma) describes the usual pattern: patches on the forehead, cheeks, nose and upper lip, or along the jaw, and sometimes on sun-exposed forearms. It helps to know which kind of dark spot you have, because they behave differently: | Type | What it looks like | Usual trigger | |---|---|---| | **Melasma** | Patches, often on both sides of the face | Sunlight, visible light, hormones | | **Post-inflammatory hyperpigmentation (PIH)** | Flat marks where a pimple, rash or injury was | Inflammation in the skin | | **Sun spots (solar lentigines)** | Small, defined brown spots on sun-exposed skin | Sun exposure | DermNet lists PIH, sun spots and several other pigment conditions as things a dermatologist rules out when diagnosing melasma, often with a Wood lamp or dermatoscope. If your marks came after breakouts, read [acne marks and scars](https://dermalguide.com/articles/acne-marks-and-scars/) instead. Any spot that changes, bleeds or looks different from the rest should be checked by a doctor. ## What causes melasma? According to the [American Academy of Dermatology (AAD)](https://www.aad.org/public/diseases/a-z/melasma-causes), melasma is much more common in women, especially between 20 and 40, and in people with medium or darker skin tones. It often runs in families. Common triggers include: - **Sun exposure**, which prompts skin to make more melanin. DermNet adds that **visible light** promotes melanin production too, not just UV. - **Hormones:** pregnancy, and birth control pills. DermNet says hormonal contraceptives, pregnancy and hormone replacement therapy are implicated in about a quarter of affected women. - **Some medicines**, including drugs that make you more sensitive to the sun. - **Tanning beds**, and possibly stress and thyroid disease. Melasma can fade on its own after pregnancy or after stopping a medicine that triggered it, the AAD says, but it can also last for years. > **Skin Realist check:** melasma is less "a spot to erase" and more "a setting your skin is stuck on". Treatment turns the setting down. Sun protection is what stops it turning back up. ## Why is tinted sunscreen the first step for melasma? Every treatment plan starts with sun protection. The [AAD](https://www.aad.org/public/diseases/a-z/melasma-treatment) recommends broad-spectrum SPF 30 or higher, shade and a wide-brimmed hat, and says dermatologists often suggest sunscreens with **zinc oxide, titanium dioxide or iron oxide**. [DermNet](https://dermnetnz.org/topics/melasma) recommends SPF 50+ sunscreen containing iron oxides as a lifelong measure. Why iron oxides? They're the pigments that give tinted sunscreen its color, and they absorb visible light, which ordinary untinted sunscreens don't block well. In a [2014 randomized trial](https://pubmed.ncbi.nlm.nih.gov/24313385/) of 68 people with melasma who all used 4% hydroquinone, those given an SPF 50+ sunscreen with iron oxide improved more over 8 weeks than those given a UV-only sunscreen: 15% more on a severity score and 28% more on color measurements. It's one trial, but it fits with what dermatologists recommend. Look for **broad spectrum**, SPF 30 or higher, and a tint, which on a label usually means iron oxides (CI 77491, CI 77492, CI 77499) in the ingredient list. Our [sunscreen filters page](https://dermalguide.com/sunscreen-filters/) lists the recorded UV filters for each product, and [the daily sunscreen guide](https://dermalguide.com/articles/the-daily-sunscreen-guide/) covers how much to apply and when to reapply. ### Dermalogica Porescreen Mineral Sunscreen SPF40 [Dermalogica Porescreen Mineral Sunscreen SPF40](https://dermalguide.com/products/dermalogica-porescreen-mineral-sunscreen-spf40/) is a broad-spectrum SPF 40 mineral sunscreen that lists **zinc oxide 10%** as its active, with **iron oxides** in the ingredient list for its light tint, plus [niacinamide](https://dermalguide.com/ingredients/niacinamide/). Dermalogica describes a lightweight, blurring, primer-like finish, applied as the last step of your morning routine. It's a good fit if you want one tinted product rather than sunscreen plus foundation. The caveat: it comes in a single "hint of tint", not a shade range, so it may not suit very fair or very deep skin. It also lists lavender extract and linalool, so skip it if you avoid scent ingredients. **→ [Check price on Amazon](https://dermalguide.com/products/dermalogica-porescreen-mineral-sunscreen-spf40/)** ### Jane Iredale Glow Fixation SPF 40 Sheer Tint [Jane Iredale Glow Fixation SPF 40 Sheer Tint Skin Enhancer with Squalane & Niacinamide](https://dermalguide.com/products/jane-iredale-glow-fixation-spf-40-sheer-tint-skin-enhancer-with-squalane-niacinamide/) lists **zinc oxide 22.75%** in every shade, for broad-spectrum SPF 40. It has sheer coverage and a luminous finish, and highlights squalane, niacinamide and allantoin. Jane Iredale lists iron oxides among the shade pigments, which vary by shade. This is the better pick if a one-tint sunscreen won't match you: it comes in five shade ranges, from Fair to Light through Dark to Deep. The finish is dewy rather than matte, so oily skin may prefer powder on top. **→ [See the Jane Iredale Glow Fixation Sheer Tint on Amazon](https://dermalguide.com/products/jane-iredale-glow-fixation-spf-40-sheer-tint-skin-enhancer-with-squalane-niacinamide/)** ## Which skincare ingredients help melasma? The AAD calls azelaic acid, kojic acid and vitamin C gentler options, and DermNet's list of topical treatments also includes tranexamic acid. Our [ingredients for dark spots](https://dermalguide.com/ingredients/for/dark-spots/) page covers each in more depth. Pick **one** to start, because stacking several mostly adds irritation, and irritation can darken pigment. | Ingredient | What the evidence says | Product with it | |---|---|---| | **[Azelaic acid](https://dermalguide.com/ingredients/azelaic-acid/)** | A [Cochrane review](https://pubmed.ncbi.nlm.nih.gov/20614435/) found prescription 20% azelaic acid lightened melasma more than 2% hydroquinone, with no clear difference against 4% | [COSRX Azelaic Acid 10 B5](https://dermalguide.com/products/cosrx-azelaic-acid-10-b5-redness-soothing-cream/) (10%) | | **[Tranexamic acid](https://dermalguide.com/ingredients/tranexamic-acid/)** | A [2017 meta-analysis](https://pubmed.ncbi.nlm.nih.gov/28374042/) found it reduced severity scores, alone or added to other treatment | COSRX Alpha-Arbutin 2 serum (with alpha-arbutin) | | **[Niacinamide](https://dermalguide.com/ingredients/niacinamide/)** | A [small 2011 trial](https://pubmed.ncbi.nlm.nih.gov/21822427/) found 4% niacinamide improved melasma with no significant color difference from 4% hydroquinone | COSRX The Niacinamide 15 Serum (15%) | | **[Vitamin C](https://dermalguide.com/ingredients/vitamin-c/)** | Listed by the AAD and DermNet as a gentler topical option | CeraVe Skin Renewing Vitamin C Serum (10%) | | **[Alpha-arbutin](https://dermalguide.com/ingredients/alpha-arbutin/)** | Used in products for uneven-looking tone; not among the treatments the AAD lists | COSRX Alpha-Arbutin 2 serum (2%) | The Cochrane authors judged the overall quality of melasma studies to be generally poor, so treat every row as "promising", not "proven", and remember the products here use different strengths from the studies. ### COSRX Azelaic Acid 10 B5 Redness Soothing Cream [COSRX Azelaic Acid 10 B5 Redness Soothing Cream](https://dermalguide.com/products/cosrx-azelaic-acid-10-b5-redness-soothing-cream/) lists **azelaic acid at 10%** in a cream base with panthenol, [niacinamide](https://dermalguide.com/ingredients/niacinamide/), alpha-arbutin and centella compounds, and is sold as fragrance free. It's a sensible first active if you also get breakouts or redness, since azelaic acid is used for those too. The honest caveat is strength: the melasma research used 20% prescription azelaic acid, and this is a cosmetic 10%. Azelaic acid can tingle or sting a little when you first start. **→ [Read reviews and check price on Amazon](https://dermalguide.com/products/cosrx-azelaic-acid-10-b5-redness-soothing-cream/)** ### COSRX The Alpha-Arbutin 2 Discoloration Care Serum [COSRX The Alpha-Arbutin 2 Discoloration Care Serum](https://dermalguide.com/products/cosrx-the-alpha-arbutin-2-discoloration-care-serum/) lists **alpha-arbutin at 2%**, with **niacinamide** and **tranexamic acid** high in the ingredient list, and is sold as fragrance free. It's the simplest way in our catalog to try topical tranexamic acid alongside other tone-evening ingredients in one serum. COSRX doesn't state the tranexamic acid percentage, so don't assume it matches the studies. The list includes alcohol, which some sensitive skin dislikes. **→ [Check price on Amazon](https://dermalguide.com/products/cosrx-the-alpha-arbutin-2-discoloration-care-serum/)** ### COSRX The Niacinamide 15 Serum [COSRX The Niacinamide 15 Serum](https://dermalguide.com/products/cosrx-the-niacinamide-15-serum/) lists **niacinamide at 15%** with acetyl glucosamine and zinc PCA, in a short, fragrance-free formula. COSRX positions it for pores, oil and uneven texture. The melasma trial used 4% niacinamide, and a higher percentage isn't proven to work better. If your skin gets flushed or itchy with strong serums, a moisturizer containing niacinamide may be the gentler route. Our [active strengths](https://dermalguide.com/active-strengths/) page compares stated percentages. **→ [See it on Amazon](https://dermalguide.com/products/cosrx-the-niacinamide-15-serum/)** ### CeraVe Skin Renewing Vitamin C Serum [CeraVe Skin Renewing Vitamin C Serum](https://dermalguide.com/products/cerave-skin-renewing-vitamin-c-serum/) lists **10% L-ascorbic acid**, the pure form of [vitamin C](https://dermalguide.com/ingredients/vitamin-c/), with three ceramides and hyaluronic acid. It's free of added fragrance and meant for the morning, under moisturizer and sunscreen, which fits a melasma routine well. L-ascorbic acid can sting at first, and the formula includes denatured alcohol. Store it somewhere cool and dark. For other options, see [the best vitamin C serums](https://dermalguide.com/articles/best-vitamin-c-serum/). **→ [Check price on Amazon](https://dermalguide.com/products/cerave-skin-renewing-vitamin-c-serum/)** ## What can a dermatologist prescribe for melasma? If skincare and sunscreen haven't helped after a few months, a dermatologist has stronger options. These are prescription decisions. This section is to help you have the conversation, not to choose a treatment yourself. - **Hydroquinone.** The classic skin-evening treatment. Since the CARES Act, the [FDA](https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products) says over-the-counter hydroquinone products are not legally marketed in the US; unapproved products had to leave the market from September 2020. The FDA has received reports of rashes, facial swelling and ochronosis (a bluish-gray discoloration that may be permanent) from OTC lighteners. - **Triple-combination cream.** Hydroquinone, tretinoin and a corticosteroid in one cream. The FDA names Tri-Luma as the approved hydroquinone product, for short-term treatment of facial melasma. The [Cochrane review](https://pubmed.ncbi.nlm.nih.gov/20614435/) found triple combination more effective than hydroquinone alone. - **Tretinoin plus a mild corticosteroid**, which the [AAD](https://www.aad.org/public/diseases/a-z/melasma-treatment) lists as another option. - **Tranexamic acid tablets.** For hard-to-treat melasma, the AAD says tranexamic acid can be taken as a pill, and that in studies it decreased melasma patches when other treatments failed. Your doctor will ask about your health first, especially any history of blood clots. - **Procedures** such as chemical peels, microneedling, and laser or light treatments. The AAD says a few studies found adding a laser or light treatment can improve results, but [DermNet](https://dermnetnz.org/topics/melasma) warns that peels and lasers can worsen melasma or cause post-inflammatory hyperpigmentation, and that several laser types carry a high risk of relapse. They belong in experienced hands. The AAD says results usually take **3 to 12 months**, and longer if you've had melasma for a long time. > **Skin Realist check:** "skin-lightening cream" bought from an online marketplace is the one shortcut worth refusing. The FDA says no OTC skin lightener is legally marketed in the US, and the side effects it lists aren't the kind that fade. ## How do you build a melasma routine? 1. **Morning:** gentle cleanser, then one active if you use it in the morning (vitamin C fits here), moisturizer if needed, then a tinted broad-spectrum sunscreen as the last step. 2. **Reapply** sunscreen when you're outdoors, and add a hat and shade on bright days. 3. **Evening:** gentle cleanser, then your one treatment (azelaic acid, niacinamide or a tranexamic acid serum), then moisturizer. 4. **Wait** at least two to three months before judging, and take photos in the same light to compare. ## Which mistakes make melasma worse? - **Saving sunscreen for beach days.** The AAD and DermNet both treat sun protection as an everyday, long-term habit for melasma, not a holiday one. - **Scrubbing or over-exfoliating.** Irritated, inflamed skin can leave its own dark marks (post-inflammatory hyperpigmentation) on top of the melasma. - **Stacking every brightening product at once.** One well-tolerated active beats four that leave skin raw. - **Buying OTC hydroquinone lighteners online.** The FDA warns consumers to avoid these unapproved products. - **Booking a laser without a melasma diagnosis.** DermNet notes some lasers carry a high relapse risk. ## The bottom line Melasma responds to patience and protection more than to any single serum. Wear a tinted, broad-spectrum sunscreen every day, choose one gentle active and give it months, and see a dermatologist if it isn't shifting. They can prescribe hydroquinone, triple-combination cream or tranexamic acid tablets. If you only buy one thing, make it a tinted mineral sunscreen such as [Dermalogica Porescreen Mineral Sunscreen SPF40](https://dermalguide.com/products/dermalogica-porescreen-mineral-sunscreen-spf40/), or the [Jane Iredale Glow Fixation Sheer Tint](https://dermalguide.com/products/jane-iredale-glow-fixation-spf-40-sheer-tint-skin-enhancer-with-squalane-niacinamide/) if you need a shade range. ## Sources - [AAD: Melasma diagnosis and treatment](https://www.aad.org/public/diseases/a-z/melasma-treatment): sun protection and zinc, titanium or iron oxide sunscreens; hydroquinone no longer OTC; triple combination; gentler topicals; tranexamic acid; procedures; 3 to 12 months. - [AAD: Melasma causes](https://www.aad.org/public/diseases/a-z/melasma-causes): who gets melasma and its triggers. - [DermNet: Melasma](https://dermnetnz.org/topics/melasma): visible light, hormone figures, patterns, differential diagnosis, iron oxide SPF 50+, and the risks of peels and lasers. - [FDA: OTC skin lightening products](https://www.fda.gov/drugs/drug-safety-and-availability/fda-works-protect-consumers-potentially-harmful-otc-skin-lightening-products): OTC hydroquinone status under the CARES Act, reported side effects, Tri-Luma. - [Castanedo-Cazares et al., 2014](https://pubmed.ncbi.nlm.nih.gov/24313385/): randomized trial of iron oxide UV-visible light sunscreen versus UV-only sunscreen with hydroquinone. - [Kim et al., 2017](https://pubmed.ncbi.nlm.nih.gov/28374042/): meta-analysis of tranexamic acid for melasma. - [Rajaratnam et al., 2010 (Cochrane)](https://pubmed.ncbi.nlm.nih.gov/20614435/): azelaic acid versus hydroquinone, triple combination, and evidence quality. - [Navarrete-Solís et al., 2011](https://pubmed.ncbi.nlm.nih.gov/21822427/): 4% niacinamide versus 4% hydroquinone. Product facts come from each brand's label as recorded on its product page. We haven't tested these products. ## Frequently asked questions ### What is the best treatment for melasma? There's no single best one. The American Academy of Dermatology says the most effective approach usually combines sun protection with a medicine applied to the skin, sometimes plus a procedure. Hydroquinone and triple-combination cream (hydroquinone, tretinoin and a corticosteroid) are the classic prescription treatments. ### Can I buy hydroquinone over the counter? Not legally in the US. The FDA says over-the-counter hydroquinone skin lighteners had to leave the market from September 2020 under the CARES Act, and it has warned companies still selling them. Hydroquinone is now available with a prescription. ### Does tranexamic acid work for melasma? There's good evidence for it. A 2017 meta-analysis found tranexamic acid reduced melasma severity scores, used alone or alongside other treatments. The AAD describes it as an option for hard-to-treat melasma, applied to the skin or taken as a pill. The pill is prescription-only, and your doctor will ask about any history of blood clots. ### Why does melasma keep coming back? Sunlight and visible light keep triggering pigment, so DermNet notes that even people who respond well may see it reappear with summer sun. The AAD says sun protection helps fade melasma and prevent it from returning, which is why sunscreen stays part of the routine after the patches fade. ### Is melasma the same as dark spots from acne? No. Melasma forms patches, usually on both sides of the face, and is linked to light and hormones. Dark marks left after a pimple are post-inflammatory hyperpigmentation. Several of the same ingredients are used for both. Amazon links on this site are affiliate links. This is general information, not medical advice.