| Broad-spectrum SPF 30+ and tinted iron-oxide SPF | Blocks the UV that re-darkens pigment. Tinted iron-oxide formulas also block visible light. | Melasma: A. The base step for post-acne marks and sun spots too. | Zinc oxide, titanium dioxide and iron oxide are the filters the AAD lists. | [1] [2] |
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| Hydroquinone | Lowers pigment production. Part of the triple cream. | Melasma: A. | Prescription only in the US. Use it only under a dermatologist's care. A systematic review lists ochronosis, a bluish-gray darkening, as a theoretical risk. | [1] [2] [3] [4] |
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| Azelaic acid | Slows excess pigment production and is well tolerated. | Melasma: B, close to B+. Comparable to hydroquinone in a meta-analysis of 3 studies. | The AAD lists it as a gentler prescription option. 20% is a strength quoted in the sources. | [1] [3] [6] |
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| Tranexamic acid, topical | Applied to the skin to reduce melasma patches. | Melasma: B. Better than placebo and similar to hydroquinone, not as strong as the triple cream. | Lowest irritation rate (0.8%) in the meta-analysis. | [3] [4] [5] |
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| Tranexamic acid, oral | A pill a dermatologist may add when melasma does not respond to other treatment. | Melasma that has not responded: A. | Prescription only. A clinician reviews your health and any blood-clot history first. We do not give dosing. | [1] [2] [4] |
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| Retinoids (tretinoin, adapalene) | Speed up cell turnover so pigmented cells shed sooner. | Post-acne marks: tretinoin B, adapalene C to B. Melasma: A only as part of the triple cream. | In one 40-week randomized trial of 54 people, tretinoin lightened marks in 40% versus 18% on placebo, and half had retinoid dermatitis. Check pregnancy use with your clinician. | [9] [7] [8] [1] |
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| Vitamin C (ascorbic acid) | Antioxidant. A supporting option, not a lead treatment. | Melasma: C. | Poor skin penetration. In one split-face trial, 15% of people with melasma improved. | [6] [1] [2] |
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| Niacinamide | Studied for reducing pigment transfer to surface skin cells. | Melasma: C, close to C+. Small studies, mostly in combinations. | Generally well tolerated. No pooled evidence yet. | [6] |
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| AHAs (glycolic acid) | Exfoliate so pigmented cells shed faster. | Post-acne marks: C for home products, B only as in-office peels, from small studies (one with 19 people). | Peels can worsen melasma or post-acne marks, so they belong with an expert. | [10] [2] |
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| Kojic acid | Lowers pigment production. | Melasma: B- to C. The weakest effect among the agents that worked, across 6 studies. | Irritation in 5.3% of people in the meta-analysis. | [3] [1] |
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| Arbutin and licorice | Plant-derived pigment inhibitors. | Melasma: C. No review-level data found for licorice on its own. | Arbutin lowered melasma scores in trials but can cause redness and itch. | [6] [4] |
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