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Medical Author:

Nili N. Alai, MD, FAAD

Nili N. Alai, MD, FAAD

Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is melasma? What are signs of melasma?
• What causes melasma?
• Where is melasma seen on the body?
• What are the types of melasma?
• How is melasma diagnosed?
• What is the treatment for melasma?
• What melasma treatments can I have at my doctor's office?
• Do lasers work for melasma?
• How does hydroquinone work in melasma?
• Are there non-hydroquinone alternative treatments for melasma?
• What is Tri-Luma?
• What SPF is recommended for melasma?
• Can melasma be prevented?
• What is the prognosis for melasma?
• Melasma At A Glance
• Patient Comments: Melasma - Causes
• Patient Comments: Melasma - Location on Body
• Find a local Dermatologist in your town
• Melasma Index

The most common melasma therapies include 2% hydroquinone (HQ) creams like the over-the-counter products Esoterica and Porcelana and prescription 4% creams like Obagi Clear, Glyquin, Tri-Luma, and Solaquin. Products with HQ concentrations above 2% generally require a prescription. Clinical studies show that creams containing 2% HQ can be very effective in lightening the skin and less irritating than higher concentrations of HQ for melasma. These creams are usually applied to the brown patches twice a day. Sunscreen should be applied over the hydroquinone cream every morning. There are treatments for all types of melasma, but the epidermal type responds better to treatment than the others because the pigment is closer to the skin surface.

Melasma may clear spontaneously without treatment. Other times, it may clear with sunscreen usage and sun avoidance. For some people, the discoloration with melasma may disappear following pregnancy or if birth control pills and hormone therapy are discontinued.

In order to treat melasma, combination or specially formulated creams with hydroquinone, a phenolic hypopigmenting agent, azelaic acid, and retinoic acid (tretinoin), nonphenolic bleaching agents, and/or kojic acid may be prescribed. For severe cases of melasma, creams with a higher concentration of HQ or combining HQ with other ingredients such as tretinoin, corticosteroids, or glycolic acid may be effective in lightening the skin.

• Azelaic acid 15%-20% (Azelex, Finacea)



• Retinoic acid 0.025%-0.1% (tretinoin)



• Tazarotene 0.5%-0.1% (Tazorac cream or gel)



• Adapalene 0.1%-0.3% (Differin gel)



• Kojic acid



• Lactic acid lotions 12% (Lac-Hydrin or Am-Lactin)



• Glycolic acid 10%-20% creams (Citrix cream, NeoStrata)



• Glycolic acid peels 10%-70%

Possible side effects of melasma treatments include temporary skin irritation. People who use HQ treatment in very high concentrations for prolonged periods (usually several months to years) are at risk of developing a side effect called ochronosis. Hydroquinone-induced ochronosis is a permanent skin discoloration that is thought to result from use of hydroquinone concentrations above 4%. Although ochronosis is fairly uncommon in the U.S., it is more common in areas like Africa where hydroquinone concentrations upward of 10%-20% may be used to treat skin discoloration like melasma. Regardless of the potential side effects, HQ remains the most widely used and successful fading cream for treating melasma worldwide. Regular medical follow-up appointments with a doctor are important for people using HQ treatment for melasma. HQ should be discontinued at the first signs of ochronosis.