What is the treatment for melasma?

Question

Hi doctor,

My mother is 45 years old, and she has dull skin and melasma-like pigmentation around her face. Please help.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I understand how concerning it is to have persistent pigmentation and dullness on the face, especially when it affects overall confidence and appearance.

Please reassure your mother that she is not alone, as melasma and uneven pigmentation are very common in women in their 40s and are often influenced by sun exposure, hormonal changes, and sometimes underlying nutritional deficiencies. With patience, proper care, and consistency, the skin can gradually look healthier and brighter. I am giving a step-by-step routine to manage this.

For treatment, apply Kojic acid cream in a pea-sized amount at bedtime on the pigmented areas, followed by a moisturizer five nights a week.
On the remaining two nights, she should use Aziderm (Azelaic acid) cream in a thin layer, followed by a moisturizer.
The face should always be washed with a gentle cleanser and left to dry for 20 to 30 minutes before applying any treatment to minimize irritation.
If she experiences mild dryness or tingling initially, this can be normal, and a gentle moisturizer may be used as needed.
Daily sun protection is the most important step in managing melasma. Guide her to apply a broad-spectrum sunscreen with SPF (sun protection factor) 50 every morning, even if she stays indoors, as sunlight through windows can still worsen pigmentation.

Reapplication every three to four hours is advised if she is exposed to daylight. She should also avoid harsh scrubs, bleaching creams, facials, waxing, or heat exposure to the face, as these can aggravate pigmentation.

In addition, it is important to check her serum iron levels, as iron deficiency is common in women and can contribute to dull, tired-looking skin and worsen pigmentation. Correcting any deficiency can significantly support skin improvement from within.

Improvement with melasma is gradual; early brightening may be noticed in four to six weeks, with more visible changes over eight to 12 weeks, and long-term maintenance is also needed. Use this for one month, and you can follow up after a month if needed to continue the medication.

Thank you for reaching out and taking such thoughtful care of your mother’s skin health.

I hope this information is helpful to you.

Thanks.