Melasma and hyperpigmentation treatment in NYC is one of the most common reasons women come to see me, and I always start with an honest point: melasma is a condition we manage over time, not something we erase in one visit. With the right plan, many patients see improvement, but the plan has to keep going to protect it.

What melasma is, and what it isn't

Melasma causes brown or gray-brown patches, usually on the cheeks, forehead, upper lip or chin. Sunlight, hormones such as hormonal contraceptives or pregnancy, heat, and even stress can trigger it [1]. When pregnancy or a medication is the trigger, melasma may fade after the baby is born or the medication stops. It can also last for years [1].

Not every dark spot is melasma. Sun spots, marks left behind after acne or irritation, and other conditions can look similar. And sometimes a skin cancer looks like an ordinary dark spot. That is why I want to look at any spot before you start fading it, so we don't lighten something that needs a different kind of care [2].

Step one: protect your skin every day

Sunlight makes skin produce more pigment, which can darken existing patches and cause new ones [1]. So every melasma plan begins with sun protection: a broad-spectrum sunscreen with SPF 30 or higher, reapplied through the day, plus a wide-brimmed hat and shade [1]. For melasma, I prefer sunscreens with zinc oxide, titanium dioxide and iron oxide [1].

My Vitamin E-ssential Sunscreen SPF 44 is a mineral sunscreen with 10% zinc oxide and 5.5% titanium dioxide and a sheer tint. You'll find more options in my sunscreen collection and more on why this step matters in the real reason you should be wearing sunscreen.

Step two: the right topical treatment

Most melasma plans include a prescription or professional-strength cream you use at home. Depending on your skin, I may recommend:

• Topical or oral Tranexamic Acid: It helps reduce the signals that stimulate excess pigment production in melasma.
• Hydroquinone, a common and effective lightening ingredient that now requires a prescription [1].
• Tretinoin plus a mild corticosteroid, or a triple combination cream that adds hydroquinone [1].
• Gentler options such as azelaic acid, kojic acid or vitamin C [1].
• Cysteamine. In a randomized trial of 50 people with melasma, a 5% cysteamine cream used nightly for four months lowered melasma severity scores more than a placebo cream [3]. I offer Cyspera, a cysteamine product.

For maintenance, some patients like my Triple Brightening Complex or Light & Bright Brightening Pads, which are hydroquinone-free. My discoloration solution set groups these together.

Step three: in-office treatments, used carefully

When creams and sun protection aren't enough, I may add a procedure. Chemical peels, microneedling, and laser or light treatments can improve results for patients who are already using a topical treatment and protecting their skin [1]. The options I use include a chemical peel, Clear + Brilliant, UltraClear, MOXI and microneedling. For sun spots rather than melasma, IPL can be an option.

With melasma, more aggressive is not better. Heat and inflammation can make pigment worse, especially in deeper skin tones, so I choose devices and settings with that in mind. If you have a deeper skin tone, my page on skin of color has more on how I approach care.

When melasma is stubborn

For melasma that hasn't responded to other treatment, a prescription medicine called tranexamic acid may help. It can be applied to the skin or taken as a pill [1]. In a placebo-controlled trial of 44 patients, those who took tranexamic acid twice daily for three months had a 49% drop in melasma severity scores, compared with 18% in the placebo group. Three months after stopping, the improvement had partly faded, to 26% versus 19% [4]. That pattern is why I talk about melasma as long-term care. Tranexamic acid isn't safe for everyone, so I review your health history first, including any history of blood clots [1].

How long it takes

With a steady plan, it usually takes about 1 to 3 months to begin to see results, and it can take longer if you've had melasma for many years [1].

Frequently asked questions

Can melasma be cured?

Melasma can fade, and it sometimes goes away after a trigger such as pregnancy ends, but it often comes back. Most people do best treating it as a long-term condition with daily sun protection and a maintenance plan [1].

What triggers melasma?

Common triggers include sunlight, hormones such as birth control pills and pregnancy, certain medications and even stress [1].

What is the best sunscreen for melasma?

Use a broad-spectrum sunscreen with SPF 30 or higher every day. Dermatologists often recommend formulas with zinc oxide, titanium dioxide and iron oxide, and a tinted sunscreen can help [1].

Do lasers help melasma?

Sometimes. Laser and light treatments can improve results for people who are already using a topical treatment and sun protection [1]. The wrong device or settings can make pigment worse, so treatment should be done by a board-certified dermatologist.

How long does melasma treatment take to work?

Most people begin to see results in about 1 to 3 months with a consistent plan. Long-standing melasma can take longer [1].

Is tranexamic acid safe for melasma?

Tranexamic acid can help stubborn melasma, but it isn't right for everyone. Your dermatologist will review your health first, including any history of blood clots [1].

About the author

Doris Day, MD, FAAD is a board-certified dermatologist and Clinical Professor of Dermatology at NYU Grossman School of Medicine. Newsweek, with Statista, consistently named her #3 on America's Best Cosmetic Dermatologists. She serves on the American Academy of Dermatology Nominating Committee (2025–present) and she advises major skin care and aesthetic companies on products and devices.

Medically reviewed by Doris Day, MD, FAAD on October 10, 2026. Last updated October 10, 2026.

Day Dermatology & Aesthetics 10 East 70th Street, Suite 1C, New York, NY 10021 (212) 772-0740

Sources

1. American Academy of Dermatology. Melasma: diagnosis and treatment. https://www.aad.org/public/diseases/a-z/melasma-treatment
2. American Academy of Dermatology. Caring for your skin in menopause (age spots and skin cancer). https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/skin-care-during-menopause
3. Mansouri P, et al. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015;173(1):209-217. https://doi.org/10.1111/bjd.13424
4. Del Rosario E, et al. Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma. J Am Acad Dermatol. 2018;78(2):363-369. https://doi.org/10.1016/j.jaad.2017.09.053