Melasma treatment options: what works and what to avoid
Melasma is one of the most common reasons people visit a dermatologist in Egypt. The brown or grey-brown patches on the cheeks, forehead, upper lip or jawline can be stubborn, and they often come back after summer. The good news is that melasma can usually be lightened significantly and kept under control. The key is choosing the right options, in the right order, and avoiding the treatments that make it worse.
First, what makes melasma different
Melasma is driven by several things at once: sun (UV), visible light and heat, hormones (pregnancy, birth control pills), genetics, and skin inflammation. It is especially common in women and in medium to darker skin tones.
Two facts shape every melasma plan:
- Melasma is usually managed, not permanently cured. Even after excellent results, it can return with sun, heat or hormonal changes.
- Melasma is easily provoked. Aggressive treatments that inflame the skin, such as harsh scrubs, strong peels at the wrong time or high-energy lasers, can make it darker.
That is why a dermatologist should confirm it is really melasma (and not sun spots or post-acne marks), and why gentle, layered treatment usually works better than one strong treatment.
Option 1: Sun and light protection (the foundation)
No treatment works for long without this. Usually recommended:
- A broad-spectrum sunscreen every day, indoors and outdoors, reapplied every few hours when outside.
- A tinted sunscreen containing iron oxides, which also helps block visible light, an important trigger of melasma in darker skin.
- Hats, shade and avoiding the midday sun.
- Avoiding heat where possible, such as saunas, steam rooms and cooking close to heat.
Option 2: Medical skincare at home
A home routine is usually the backbone of melasma treatment. Depending on your skin, a dermatologist may use ingredients such as:
- Tyrosinase inhibitors that slow pigment production, such as azelaic acid, kojic acid, arbutin and, under medical supervision, hydroquinone.
- Tranexamic acid in topical form.
- Supporting ingredients such as niacinamide, vitamin C and gentle retinoids, which help brighten and renew the skin.
A warning about bleaching creams. In Egypt, strong lightening creams are easy to buy without a prescription. Some contain high-strength hydroquinone or hidden steroids. Used for long periods without supervision, they can cause thinning skin, acne, visible blood vessels and, with long-term hydroquinone, a permanent blue-grey darkening called ochronosis. Use pigment creams only as part of a dermatologist's plan.
Option 3: Depigmentation peel systems
Professional depigmentation systems such as Cosmelan and Dermamelan are designed for stubborn pigment and melasma. A mask is usually applied in clinic and left on for a set number of hours, followed by a home maintenance cream. Expect several days of redness and peeling as the skin renews. NeoDerma also offers Meladeep and Cimel, chosen by the doctor according to your skin.
Option 4: Chemical peels
Gentle, superficial peels can lift surface pigment and help home treatment work better. For melasma, peels are usually kept mild and spaced out, because strong peels can trigger rebound darkening, especially in medium and darker skin. See Chemical peels.
Option 5: Laser toning
Low-energy Q-switched laser toning, such as on the Lutronic Spectra, breaks up excess pigment with very little heat. It usually needs a series of short sessions a few weeks apart, with minimal downtime, and is used for selected melasma cases as part of a combined plan. Settings must be conservative: too much energy can cause rebound pigmentation or white spots.
Option 6: Oral treatment (doctor decision only)
For some stubborn cases, dermatologists may consider oral tranexamic acid. It is a prescription medicine and is not suitable for everyone, for example people with a history of blood clots, some heart conditions, smokers on hormonal contraception, or during pregnancy. It is only used after a full medical assessment.
What usually does not help, or makes melasma worse
- Harsh scrubs, loofahs and DIY lemon or baking-soda masks.
- Strong peels or aggressive lasers without preparation and aftercare.
- Unsupervised bleaching or steroid creams.
- Skipping sunscreen between treatments.
- Stopping maintenance as soon as the skin looks better.
How a typical plan comes together
Most melasma plans combine several of these options:
- Diagnosis, to confirm melasma and check for triggers such as hormones or irritating products.
- Preparation with sun protection and a home routine for a few weeks.
- In-clinic treatment, such as a depigmentation system, gentle peels or laser toning.
- Maintenance, with the home routine, daily sun protection and periodic check-ups, especially before and after summer.
Improvement is usually gradual over weeks to months.
Melasma in pregnancy
Melasma often appears during pregnancy. Many treatments, including several creams, peels and lasers, are usually postponed during pregnancy and breastfeeding. Gentle, pregnancy-safe skincare and strict sun protection can still help, and melasma sometimes fades after delivery. Ask a dermatologist before starting anything.
What NeoDerma offers for melasma
At NeoDerma, melasma plans can include Cosmelan, Dermamelan, Meladeep, Cimel, Lutronic Spectra laser toning, chemical peels and medical skincare, with conservative planning for melasma-prone skin and a maintenance and sunscreen strategy to reduce recurrence. See Pigmentation and melasma.
Frequently asked questions
Can melasma be cured permanently?
Melasma is usually managed rather than cured. Treatment can lighten it significantly, and maintenance keeps it under control.
What is the best treatment for melasma?
There is no single best treatment. Daily sun protection plus a combination, such as medical skincare with a depigmentation system, gentle peels or laser toning, usually works best.
Does laser work for melasma?
Low-energy laser toning can help selected cases as part of a plan. Aggressive lasers can make melasma worse.
Is Cosmelan good for melasma?
Cosmelan is a depigmentation system designed for stubborn pigment and melasma. It is usually followed by a home maintenance cream and daily sun protection.
Why does my melasma come back every summer?
Sun, visible light and heat are strong triggers. Strict sun protection and a maintenance plan before summer help reduce recurrence.
Can I use a lightening cream from the pharmacy?
Strong lightening creams can harm the skin when used without supervision. Use pigment creams only as part of a dermatologist's plan.
Get a melasma plan
Book a skin assessment at NeoDerma in Trivium Business Complex, North Teseen Street, Fifth Settlement. Open Saturday to Thursday, 12:00 PM to 9:00 PM (closed Friday). Prices are not listed online; message us on WhatsApp for a quote.