Treating melasma safely in Indian skin

Key takeaways

• Sun and visible light protection come first. Without it, no cream or laser holds its result.
• Prescription creams are the backbone of treatment, but they must be supervised and used for limited periods.
• Oral tranexamic acid is an option for difficult melasma, after checking for any history of blood clots.
• Peels and lasers can help some people, but they can also worsen melasma in brown skin if used aggressively.
• Melasma is managed long term. Plan the maintenance phase from the start.

Where does melasma treatment start?

Someone comes in and says, "Doctor, just do the laser and finish it." I'm happy to discuss lasers. But have you understood what melasma does in your skin? If we laser it without protecting from light and calming the pigment cells, it can come back darker. So we start somewhere much less exciting: sunscreen.

Protection, every day - A broad-spectrum sunscreen of SPF 30 or higher. The American Academy of Dermatology suggests sunscreens containing zinc oxide, titanium dioxide or iron oxide for melasma. - Tinted, with iron oxide. DermNet recommends broad-spectrum SPF 50+ tinted sunscreens with iron oxides, and the Indian Sunscreen Forum's 2025 consensus prefers mineral sunscreens with iron oxide for melasma, because they also block visible light. - Indoors too. The same consensus advises melasma patients to keep using sunscreen indoors. - Reapply every two to three hours when outdoors, and use a wide-brimmed hat or umbrella.

The basic rules on amount and reapplication are in my guide to sunscreen for Indian skin.

Which creams are used for melasma?

These are prescription decisions. I have listed them so you understand the options, not so you can buy them over the counter.

DermNet reports that triple combination cream clears or improves 60 to 80% of cases. That is a good figure, but here is the truth: once you stop, if protection is weak, the melasma tends to return.

A word about mixed creams. In India, many people use creams bought from a chemist or online that contain a steroid mixed with lightening agents, often for years. The steroid can thin the skin, cause redness, acne and visible blood vessels, and make the face dependent on the cream. The American Academy of Dermatology also warns about products with undisclosed steroids or mercury. If you are using a cream like this, do not keep using it unsupervised. Bring it to your consultation.

Is tranexamic acid tablet safe for melasma?

Oral tranexamic acid is used for melasma that is hard to treat. DermNet explains that it works on a pathway involved in melasma pigment, and the American Academy of Dermatology notes it is usually taken alongside creams and sun protection.

It is not suitable for everyone. The American Academy of Dermatology specifically advises telling your doctor if you have had a blood clot. I check your medical history, any clotting problems, smoking, hormonal contraception and pregnancy plans before considering it. It is a prescription decision made after assessment, with review dates.

Do peels and lasers help melasma in Indian skin?

They can help some people, but this is where caution matters most in brown skin.

Chemical peels Superficial peels, such as glycolic acid, can remove surface pigment. DermNet warns that peels can also worsen melasma or cause post-inflammatory darkening, and advises pretreatment with a pigment-lowering cream. The Indian guidelines on chemical peels list melasma among indications and note that superficial peels are considered safe in Indian patients, while medium-depth peels need great caution. My guide to chemical peels explains depths.

Lasers and light DermNet notes that lasers, IPL and microneedling carry a high risk of relapse and of making melasma harder to treat, and need expert use. The American Academy of Dermatology says some studies show added benefit when lasers are combined with medicines and sun protection.

See, what happens is, melasma skin is already "switched on". Heat and injury switch it on further. So if I use a laser for melasma, it is gentle, spaced, and only after the creams and protection are working. Never as the first step, and never as the whole plan.

PRP The American Academy of Dermatology lists platelet-rich plasma among procedures being used for melasma. It is available at our centres, but I see it as a possible add-on, not a main treatment.

How long does melasma treatment take?

The American Academy of Dermatology says results usually take three to twelve months, and longer if melasma has been present for a long time. Deep (dermal) melasma responds more slowly than surface melasma.

What I tell my patients: - Months 1 to 3: protection becomes a habit; creams start to lighten surface pigment. - Months 3 to 6: visible fading in many people; we adjust or add treatments. - After that: step down to a gentler maintenance routine, often azelaic acid or similar, with strict sunscreen.

That is very important to understand: the maintenance phase is not optional. It is the endgame of the plan, and I plan it on day one.

What can I do at home to support treatment?

• Sunscreen every morning, reapplied when outdoors. Tinted if possible.
• A cap, wide-brimmed hat or umbrella for the commute.
• Avoid steam rooms and long hot-kitchen exposure where you can, or protect your face.
• Do not scrub, wax or bleach the face.
• No lemon, haldi pastes or DIY packs on melasma patches. Irritation adds pigment.
• If you are on hormonal contraception, discuss it with your gynaecologist. DermNet notes stopping hormonal contraception, where possible, is part of general management.

How we approach this at Dr Tvacha

At Thane, Andheri, Bandra and Dahisar, I start with a diagnosis: confirming it is melasma, judging the type, and listing your triggers. The plan follows the clinic's order of Diagnose, Treat, Protect, Maintain, and it is written down, with fees, before you pay. The Rs 499 skin consultation is the starting point. Treatments available at our centres include chemical peels, laser therapy and PRP, used only where they add benefit. Read about the Second Layer Skin Plan or find a centre. For background, see melasma: why it happens.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.