Recovery
Results
Treatment Time
Aftercare
The science of skin care
- Skin care forms the foundation of melasma treatment & prevention
- Antioxidants protect the skin from UV & environmental damage
- Pigment correctors reduce melanin production
- The best ingredients include azelaic, ascorbic & alpha hydroxy acids
- A tailored skin care routine provides the best results
- We combines skin care with lasers & chemical peels for fast results
What is the aim of skincare when treating melasma?
Melasma skin care has 4 main aims-
- Protect against UV & visible light; this is the role of sunscreens.
- Defence against oxidation, this is the role of antioxidants.
- Reduce pigment, this is achieved via pigment correctors that reduce melanin.
- Repair the dermal layer of skin, this is the role of anti-aging formulations.
What are examples of pigment correctors?
Pigment correctors work in melasma by reducing the activity of an enzyme called tyrosine. This group of creams are termed tyrosinase inhibitors. There are over 25 mainstream tyrosinase inhibitors that are available in different concentrations & different combinations.
Examples of pigment correctors include azelaic acid, arbutin, ascorbic acid, niacinamide, kojic acid, bearberry extract, liquorice root, hydroquinone, cysteamine, as well as novel chemicals such as thiamidol.
Where to start/what is a basic skin care routine for melasma?
A basic routine starts with sun protection. Once you have mastered this step, add topicals.
AM: SPF 50+, tinted.
Midday: SPF 50+, tinted.
PM: Azelaic acid 15%
*The biggest traction you can get out of any routine is the correct use of sunscreen, namely SPF 50+, tinted, 2 finger lengths, twice daily, regardless of exposure.
What is an intermediate skin care routine for melasma?
Once you have graduated from the basics, you may elect an intermediate skin care routine. Each time you step up the melasma treatment ladder, you increase the complexity of topical application.
AM: Antioxidants; SPF 50+, tinted.
Midday: SPF 50+, tinted.
PM: Azelaic acid 15% or L-ascorbic acid, if both are used, separate application time by 30 minutes.
*The biggest traction you can get out of any routine is the correct use of sunscreen, namely SPF 50+, tinted, 2 finger lengths, twice daily, regardless of exposure.
What is an advanced skin care routine for melasma?
Once you thoroughly understand the value of sunscreen & your skin’s irritant threshold, escalate your skin care routine to an advanced multi-step routine.
If you don’t understand the basics, don’t employ an advanced skin care routine, you will probably cause skin irritation & worsen your melasma.
AM: L-ascorbic acid, ferulic acid, tocopherol, SPF 50+, tinted.
Midday: SPF 50+, tinted.
PM: Azelaic acid 15% & or ascorbic acid. Option for novel formulations of arbutin, kojic acid, botanicals, azelaic acid, & others.
Pulsed: once a week AHA (glycolic or lactic acid) serum 8-18% in the evening.
*The biggest traction you can get out of any routine is the correct use of sunscreen, namely SPF 50+, tinted, 2 finger lengths, twice daily, regardless of exposure.
Our dermatologists have carefully chosen the very best pigment targeted skin care from leading brands to effectively treat & prevent melasma pigmentation.
How do we select the best skincare for pigmentation?
Our clinicians work with an algorithm to come up with a customized skincare routine for melasma pigment. We take into consideration-
- Clinical examination of your pigment type using polarized light & dermatoscopy
- Pigment output & depth of pigment
- Your skin’s sensitivity
- Previous success & failures
- Combination of lasers & chemical peels that we employ for your type of melasma
It’s a highly complex task. If you would like to understand this process more, read the explanation at the bottom of this page.
How soon will melasma lighten if skin care is going to work?
Despite marketing claims, it takes 4-6 weeks before you notice a reduction in melasma pigmentation.
- Fast results: alpha hydroxy acids, high strength retinoids. These act as exfoliant.
- Slower results: niacinamide, ascorbic acid, azelaic acid, kojic acid.
- Very slow results: anti-aging agents.
*Ingredients work synergically. It is the balance between exfoliation & pigment inhibition that provides results. Cellular remodelling is complex & takes the longest time.
**Best results are seen when pigment correctors are combined with a tailored laser or peel program.
Can I use only skincare to treat melasma?
You may receive some fading of pigment with basic skincare; however, our clinic always combines medical management together with lasers & novel peels.
Lasers address the causes of melasma, namely cellular aging & activity of pigment cells, whilst skin care reduces pigment output & protect the skin from UV & environmental damage.
We employ & combine lasers & energy based devices including pico, Q switch, vascular, fractional & RF microneedling to effectively treat over 80% of melasma cases.
Our clinicians combine skin care with lasers & chemical peels to markedly increase the efficacy of our melasma treatments.
Why are antioxidants important in the treatment of melasma?
Antioxidants are the second layer of defense after sunscreens. They help protect skin cells from UV & environmental damage. This is especially important for pigmentation conditions such as melasma & age spots. They are best applied in the morning. Here are our favourites.
- Vitamin E or tocopherol
- Vitamin C or ascorbic acid
The ideal concentration & formulation depends on your skin type & sensitivities. We also prescribe silymarin, green tea, polypodium & niacinamide.
What is better, prescriptive topical creams or over the counter creams?
It’s not an easy decision, however with the power of marketing, many online companies will try to convince you that a compounded ‘bespoke’ or ‘tailored’ cream formulation for melasma is the best. That’s far from the truth. In our experience, these online consultations don’t understand the type of pigmentation you have (diagnosis involves close clinical examination).
With correct formulations, compounded formulations can be more effective compared to OTC (over the counter) products without prescription. The flipside? Not everyone requires compounded formulations. Additionally, prescriptive medications have a much higher side effect profile compared to formulations such as Lytera 2.0, Meladerm, Eucerin Anti-Pigment formula, MelaB3, Azclear & Melanopro.
The Melasma Clinic hand picks the best pigment correctors across dozens of brands. We also prescribe bespoke formulations to effectively lighten melasma within a short span of time.
When can I restart my creams following pico laser or a chemical peel?
Creams are applied from one minute after a procedure to 9 days, depending on the topical & procedure. Our clinical team will guide you as to the timing. As a general rule-
- Pigment correctors: 1-3 days after laser, or 2-9 days after peels.
- Sunscreen application: immediate to 8 days post procedure (depending on the sunscreen).
- Antioxidants for melasma: 1-9 days after the procedure.
What is the cost of melasma treatment creams?
Creams range in price from $10 to well over $280. In our opinion, the price of creams does not reflect their efficacy in treating melasma. Some cheap formulations are excellent, whilst super expensive topicals often disappoint. Here are some facts-
- The Ordinary produces great washes but leave-on formulations such as arbutin aren’t great.
- Azelaic acid is a cost-effective starting point.
- Spend money on a dual-purpose serum, e.g. Combinations of L-ascorbic acid, ferulic acid & tocopherol as this reduces oxidative stress & pigment production.
- Super-expensive novel formulations often disappoint.
- Spend your money on sunscreen over pigment correctors. Over 95% of melasma patients don’t get this right.
Why do beauticians & aestheticians avoid prescribing hydroquinone?
Because they can’t legally prescribe it. In Australia the highest strength HQ that can be purchased without a prescription is 2%. HQ is found in Superfade. In some parts of the world, it is illegal. This is why the average cosmetic clinic will sell you the Cosmelan or Dermamelan Peel, followed by Cosmelan 2 products. It’s called restrictive marketing.
On the flipside, companies like Software & QR8 will try to sell you hydroquinone, simply because they found a loophole in the prescribing system, namely they pay a remote GP to say hello to you online, then legally prescribe this medication.
Our ethos is to prescribe topicals based upon your pigment type, depth, morphology, skin sensitives & combination therapies that yield the best results.
The Melasma Clinic difference
Our specialist clinic is overseen by dermatologists who provide a comprehensive & bespoke approach to skin care. Our pigment solutions include preventing future recurrences of melasma. Our ethos is to improve & maintain your skin’s health & vitality as an ongoing commitment to our patients.

More of our mostFrequently asked questions
What is the best skin care for melasma patients with sensitive skin?
What is the best skin care for dermal melasma or resistant melasma?
Are creams effective in all cases of melasma?
What is Cosmelan 2 & is it good for pigmentation?
What is the best sunscreen for melasma patients?
How good is retinol for pigmentation?
What is tranexamic acid and is it any good?
How good is Cysteamine or Cyspera for melasma?
What is azelaic acid & is it good for melasma?
Is hydroquinone safe?
Is tretinoin good for melasma?
What about niacinamide for melasma?
How do we rate thiamidol for melasma?
What can AHAs like glycolic & lactic acid do for melasma?
What is the role of anti-aging skincare for melasma patients?
What is MelaB3 and is it any good for melasma?
How good is arbutin for melasma?
Why do 95% of melasma sufferers pick skin care over sunscreen?
What skincare is safe in pregnancy related melasma?
What do we recommend for natural melasma treatment?
What types of creams do we prescribe for mature onset melasma?
Should I add supplements with skin care?
Should I try exosomes for melasma?
A SummaryMelasma skin care guide
Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney
It’s not as easy as the ‘ingredient list’ or the best product, hence why we tailor the algorithm to every melasma patient. Here is a guide as to my thought processes when it comes to pigment creams & how I tailor prescriptions, try & follow the synapses as we figure out the optimal formulation.
Best pigment corrector creams; pairing with your skin type & sensitivity.
This is a textbook chapter in itself, but here is the logic behind our approach of pairing melasma creams with your skin type & innate skin sensitivity.
- Powerful creams such as hydroquinone & cysteamine have a higher skin irritant rate.
- These creams, especially HQ, are harder to modulate with significantly higher side effects if used incorrectly.
- There is a very fine line between the efficacy of cream formulations vs that of making melasma worse via skin irritation. Tretinoin is an example.
- Skin irritation compromises your skin barrier function, over-cooking this & post inflammatory hyperpigmentation can occur.
- Inflammation of skin leads to release of inflammatory markers such as leukotrienes. These agents further stimulate your pigment cells, resulting in worsening of melasma.
- Skin sensitization (innate vs acquired) has variable factors including skin conditions such as eczema, rosacea, seb. dermatitis, perioral dermatitis (mostly due to all the pigment correctors patients will inevitably try for their melasma) in addition to the skin irritant potential of melasma creams such as those outlined, plus the whole ‘pigment corrector ingredient list’ of the usual suspects such as kojic acid, retinol, vitamin C (acidic with a very low pH in highly bioavailable formulations) plus AHA such as glycolic & lactic acids etc…
- Sensitive skin variables also include age of the patient (menopause vs premenopause), climate (winter = dry skin) with transient factors such as travel, stress, procedures such as lasers & chemical peels etc.
Taking everything into consideration, the best pigment corrector has no exact formulation, not until AI can find an algorithm taking into consideration all of the above factors. Our clinicians hence formulate a bespoke, customised skin care protocol that matches our laser & chemical peel solutions for melasma pigment, taking into consideration your skin sensitivities. Let’s add to the algorithm the factors below.
Best pigment corrector creams; pairing with your pigment depth & type of pigmentation
Again this is several textbook chapters; but here’s the attenuate thought processes.
- Deep pigmentation such as dermal melasma will not respond to creams such as Cosmelan 2, hydroquinone, cysteamine or glycolic, lactic or salicylic acids.
- Dermal melasma skin care- products may marginally help with this condition. Skin care is again adjunctive to lasers & procedures.
- Pigment is multifactorial in most cases of melasma. Some forms of pigmentation such as Hori, lentigo or age spots do not respond to creams & topical formulations.
Best pigment corrector creams; pairing with pigment removal methods
Less complex, but here’s the concept.
- Recovery from lasers & peels will compromise your skin’s barrier function.
- Timing of the correct skin care is essential to prevent or at least reduce irritation.
- Timing of skin care following laser depends on the type of laser wavelength used, eg. pico has much less healing than others.
- Fractional lasers such as Fraxel, Moxi, LaseMD & Clear & Brilliant may increase the absorption of topical creams (tranexamic acid).
- Cream formulations may be combined depending on the diagnosis.
Best pigment corrector creams- scientific studies are rigged.
Yes, most studies are self-funded by the parent company. The results may be skewed to the end result, which is always favorable. This applies to most melasma pigment correctors that are novel proprietary formulations, hence the true efficacy rate may not reflect the findings in the studies. These companies & formulations include-
- MelaB3 by La Roche Posay
- Cosmelan 2 & the Cosmelan Peel
- Thiamidol formulations by Eucerin
- Cysteamine
Best pigment corrector creams- when you do your ‘research’ on Google & Reddit
Sometimes (most times), we’re too tired to argue. If your limited research shows that HQ causes cancer, or if you think nanoparticles are accumulating in your vital organs, then chances are we’re going to prescribe you azelaic acid.
Rest assured we apply scientifically sound prescriptive habits to each case, but if you’re a nutter, perhaps you should see a naturopathetic skin care specialist, not a dermatologist.
Spend money on sunscreen over ‘actives’, lasers & peels
Our existence as a clinic is for one purpose- to solve your pigment issues. We’re not here to sell you creams, lasers, peels or advice. You have it FREE on this website. If you read the instructions & your pigment is solved, that’s one less patient we need to sort out.
If you are going to spend your hard earned money on a solution, start with sunscreen before anything else. We can not alter the genetics of melasma, we’re not going to advise removing your ovaries to regulate hormones, but you can start with adequate photoprotection. Here is the math-
- Minimum of 2.5 ml/grams per application, i.e. 5 ml per day.
- One bottle = 10 days.
- One good bottle of sunscreen sets you back 25-75 dollars.
- In one month you’re spending between 75 bucks to 220 AUD on sunscreen alone.
If you have not mastered proper sunscreen application, we suggest you start it. Without sunscreen your chances of improving melasma approaches zero. Facts.
Why pair creams with lasers & or novel peels
Here’s the skinny on things. Pigment creams work primarily by inhibiting melanin production, which leads to gradual fade of melasma pigmentation. They don’t treat melasma at the cellular level, namely modulation of the melanocyte itself. Additionally creams have a very limited capacity to remodel the dermal layer of skin, which as we all know, plays an important role in melasma remission, via reversing cellular aging (also known as cellular senescence).
Laser, such a Picosure Pro, used in the correct settings work by-
- Reducing pigment in the upper layers of skin via a process called selective photothermolysis. Pico lasers generate far less heat compared to Fraxel & Q switch lasers as they provide more photomechanical properties compared to photothermal.
- Pico lasers using larger spot sizes & even lower energy can treat dermal pigmentation. They have a role in treating the dermal, or deeper component of melasma.
- Remodelling the dermal layer of skin
- Reducing the activity of melanocytes. A pivotal study in 2024 entitled ‘Modulation of Melanocyte in Melasma Patients After Picosecond Laser Treatment’ by Chen & colleagues was recently published in the Journal of Cosmetic Dermatology, the summary is outlined below. A super short summary of the paper is that pico lasers shorten the width & length of the ‘arms’ of pigment cells. This confirms the suspicion that pico lasers not only remove pigment, but also modulates the pigment cell itself, which may lead to long term remission.
Fractional lasers on the other hand work treat melasma via a very different process, known as dermal remodelling or reversal of cellular senescence. These lasers include pico lasers (in special fractional settings) or non-ablative lasers such as Fraxel, Moxi & LaseMD Ultra. They work via-
- Increasing absorption of topical melasma creams such as tranexamic acid, arbutin, ascorbic acid, kojic acid, niacinamide & others.
- Changing of cellular architecture in the deeper layers of skin (dermal remodelling).