What is standard protocol for treating melasma?

How long is Tri-Luma used for? Some dermatologists state that using it for 3-4 months is safe. Also, is oral tranexamic safe for melasma sufferers?

Doctor Answers 5

Start melasma treatment with Melarase creams

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I would begin with twice daily use of Melarase creams followed by Clear and Brilliant laser to help even out color and texture. 


Dr. Karamanoukian

Los Angeles

Protocols vary for melasma management.

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Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. To answer your question, once I get melasma faded, I slowly reduce the Tri Luma or HQ, and replace this with Lytera. You will need life long management, and a combination of non- HQ- cortisone based creams, peels and lasers can help.  In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid. All the best, Dr Davin Lim Laser, surgical and aesthetic dermatologist Brisbane, Australia 

Cosmelan and Melasma

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Cosmelan is the best treatment for patients who suffer from Melasma.  I would recommend consulting with a doctor who performs these peels.  Lasers can often make melasma worse.  Best, Dr. Green

Melasma and Sun Spots -- Best Treamtent Is Clear + Brilliant / Fraxel 1927 / Aerolase w Microneedling PRP, Pro Yellow is Useful

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There is no "cure" for melasma but there are great treatments. We are doing a clinical trial now on clear + brilliant with bleaching and microneedling and getting amazing results. I suggest you see an expert. You will need lifelong treatment, sun protection, skin care. But these treatments can give you improvement and then you maintain. Tranexamic acid has no effect on melasma. Best , Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 202 reviews

Tri-Luma for melasma

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Thank you for your question complexionme. Melasma is a common concern where dark patches appear on certain areas of the face and body such as the cheeks, forehead, and upper lip. Melasma is challenging to treat because it is caused by an imbalance of hormones in the body that makes the skin more sensitive to the sun. So no matter what we do for the skin, the hormones will still be there and the melasma will come back. I tell my patients that melasma is a condition that we control, not cure. Continuous treatment and maintenance are required. Tri-Luma is a product commonly used for melasma which contains hydroquinone, retinoic acid, and a steroid. Often times people use it for three to four months then take a break for a month before restarting it. For my patients I recommend starting with a good skin care regimen including the A E Skin Brightening Cream (which contains similar ingredients as Tri-Luma and also kojic acid), an exfoliant, an antioxidant, a hydrating product, and sunscreen. After approximately two months, treatments can be done and the risk of darkening is reduced. I do not have experience with tranexamic acid, but I have heard some doctors recommend it. Please consult with a doctor for specific recommendations. Good luck!

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