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Got Patchy Skin? Learn About Melasma Treatment for Youthful Skin

Do you have patches on your face? Don’t worry, there are many melasma treatments that work for your skin.

Woman with melasma examines her face in the mirror

You’ve probably seen advertisements on television, radio, and social media touting skincare products for melasma treatment. It is a common skin condition that can affect as many as one in every three women. Meanwhile, as many as one out of two pregnant women are prone to melasma. It’s sometimes called the “mask of pregnancy” due to the hormonal changes involved. This condition affects women in their reproductive years, and even men, though it less common. 

What Causes Melasma  

Melanin accumulation is characterised by over-active melanocytes in the skin layers that are responsible for creating the pigment melanin that gives our skin its colour. This can cause melasma. The causes could be related to sun exposure (similar to hyperpigmentation), or hormonal effects, whether through internal hormonal changes like pregnancy or thyroid disease, or externally due to synthetic hormones such as taking birth control pills. Melasma is also hereditary, so if you have a blood relative with melasma, you could be prone to developing it as well. 

Symptoms and Types of Melasma  

Unlike age spots, liver spots, or sun spots, melasma is a type of hyperpigmentation that usually covers a larger area of the face. It’s not necessarily associated with ageing, though hormonal changes can make it worse. It may begin with smaller spots in lighter shades, and then darken over time, especially with increased sun exposure.

There are three types of melasma: 

  1. Epidermal, which is dark brown  
  2. Dermal, which appears light brown or bluish,  
  3. Mixed melasma, which has both brown and bluish patches. Epidermal melasma seems to respond to treatment the best, depending on the affected areas 

The condition can develop over a period of weeks or months and is considered a chronic condition which may come and go. For women who get it due to pregnancy, it often disappears once the baby is delivered. However, melasma is not a physically harmful condition, nor is it painful or itchy. 

Different Options for Melasma Treatment

Woman lying down while dermatologist performs micro needling on her face
Micro needling is a facial rejuvenation therapy similar in principle to facial acupuncture

Wearing sunscreen regularly is your best defence in preventing the development or worsening of melasma. Fortunately, there are many options to treat it but it’s important to have a dermatologist diagnose you to confirm that you have melasma, and to ascertain the cause. 

The following are topical creams your dermatologist may prescribe: 

  • Hydroquinone: Prevents pigmentation via enzymatic pathways that interrupt the skin’s pigmentation process.  
  • Tretinoin and a mild corticosteroid: Renews skin and controls inflammation.  
  • Triple combination cream: Combines ingredients from the above into one cream. 
  • Azelaic acid, kojic acid or vitamin C: Possesses renewal and exfoliating properties but are much gentler. 
  • Tranexamic acid: May be prescribed for stubborn melasma, whether topically or orally, but with contraindication for those with blood clot risk. 

Other Approaches to Melasma Treatment 

Dried liquorice root pieces and powder in bowls
Liquorice root (Gan cao, 甘草) is one of several TCM herbs known for their efficacy in treating melasma.

According to Traditional Chinese Medicine (TCM) physician Lim Sock Ling, melasma is due to a lack of nourishment of the face. This could arise from three causes: 

  1. Liver qi (vital energy) Stagnation, which can cause poor blood circulation of the face. Over time, the stagnation results in fire (yang) which diminishes the blood (yin), causing the face to be dull and making it susceptible to melasma. 
  2. Kidney Deficiency which implies essence (jing) Deficiency, and therefore blood Deficiency, resulting in lack of nourishment to the face.  
  3. Spleen Deficiency which causes as lack of qi and blood to nourish the face 

TCM treatment principles for melasma, like other hyperpigmentation conditions, focuses on: 

  1. Easing Liver qi, thereby removing Blood Stasis 
  2. Invigorating qi and nourishing blood 
  3. Nourishing yin and invigorating the Kidneys  


Physician Lim reveals that TCM is effective in treating melasma. A study of 113 participants who received short acupuncture regimens of five to 10 sessions for melasma treatment had only minor side effects. 

Interestingly, a recent modern development in Western medicine called micro needling, also shares similar principles and mechanism as facial acupuncture. The idea behind both treatments lies in improving circulation to the face, removing stasis, and promoting regeneration of skin cells, resulting in a more radiant, uplifting effect.

“In a study conducted at Xiamen University Affiliated Hospital, researchers concluded that acupuncture significantly achieved a better outcome as compared to hydroquinone. Acupuncture along the yang ming Stomach meridian was effective in lightening the skin. It had a total efficacy rate of 82.22% which is higher as compared to the control group using hydroquinone cream with an efficacy rate of 62.50%,” Physician Lim shares. The World Health Organization (WHO) recognises acupuncture as a promising treatment for chloasma, another name for melasma. 


To complement acupuncture, TCM practitioners also prescribe herbs that help to promote qi and blood circulation, relieve depression, as well as nourish and brighten the skin to slow down the onset of melasma. 

Pearl powder is a popular ingredient in natural skincare products. In ancient times, Wu Ze Tian, a Chinese empress, used it to beautify her skin. Pearl powder contains amino acids which stimulate skin cells to produce collagen, promote cellular repair and encourage hydration.

It also contains high levels of calcium to promote skin regeneration and hydration and regulates sebum and cell turnover. Moreover, calcium strengthens bones and is useful for osteoporosis, another condition that affects women. Trace minerals such as magnesium and potassium help to maintain skin’s health. In TCM, pearl powder calms the mind, as a relaxant and has an anti-inflammatory effect.

Other TCM herbs that are great for melasma treatment include: 

  • Liquorice root (Gan cao, 甘草): Possesses anti-inflammatory effects and inhibits tyrosinase, a key enzyme responsible for making the pigmentation.  
  • Gotu kola (Ji xue cao, 积雪草): Helps with the lightening of dark spots by clearing Heat and Dampness, reduce toxins and swelling. It has antimicrobial, antidiabetic, anti-inflammatory, anti-depressant, and memory-enhancing properties.  
  • Sanchi (also known as Tian Qi, 田七, Panax notoginseng): An active ingredient found in facial creams to improve the condition of melasma. Panax notoginseng saponins (PNS), a constituent of Sanchi, exhibits multiple health benefits, including improvements in microcirculation, anti-inflammation, and anti-oxidation. 

Melasma can be quite a confidence dampener. Fortunately, there are effective treatment options from both Western and TCM perspectives. Even if your melasma does not affect your confidence, it’s still crucial to keep an eye on it. As the saying goes, beauty is not just on the outside but skin-deep, and can reflect what is going on on the inside. 


  1. Cleveland Clinic. 2020. Melasma. [Accessed 27 March 2022]. 
  2. American Academy of Dermatology Association. 2022. Melasma: Diagnosis and Treatment.  [Accessed 27 March 2022]. 
  3. The Journal of Clinical and Aesthetic Dermatology. 2019. Tranexamic Acid for Melasma: Evaluating the Various Formulations. [Accessed 27 March 2022].
  4. American Osteopathic College of Dermatology. Hydroquinone. [Accessed 27 March 2022]. 
  5. Frontiers in Public Health. 2021. Short Practical Regimen of Acupuncture for Melasma: A Prospective Cohort Study in a Tertiary Hospital in Thailand.  [Accessed 27 March 2022]. 
  6. Evidence-Based Complementary and Alternative Medicine. 2018. The Effects of Acupuncture Combined with Auricular Acupressure in the Treatment of Chloasma.  [Accessed 27 March 2022]. 
  7. Healthcare Medicine Institute. 2018. Acupuncture Beats Drug For Melasma Treatment.  [Accessed 27 March 2022]. 
  8. Journal of Cutaneous and Aesthetic Surgery. 2013. Cosmeceuticals for Hyperpigmentation: What is Available? [Accessed 27 March 2022].
  9. Journal of Cosmetic Dermatology. 2019. A cream of herbal mixture to improve melasma. [Accessed 27 March 2022]. 
  10. Journal of Food and Drug Analysis. 2018. Efficacy of protein rich pearl powder on antioxidant status in a randomized placebo-controlled trial. [Accessed 27 March 2022]. 

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