Melasma may be very difficult to treat. The pigment of melasma develops gradually, and resolution is also gradual. Resistance and recurrences occur quite often and are certain if you don't strictly avoid the sunlight.

As melasma is a completely benign skin disorder with no untoward health consequences, the treatment is only for cosmetic reasons. Many treatment methods are very expensive and there is no guarantee that they will work at all. In fact, some treatments can even worsen the condition.

Hydroquinone (HQ)
Hydroquinone (HQ) is used most commonly. It is a hydroxyphenolic chemical that inhibits tyrosinase, leading to the decreased production of melanin. HQ can be applied in cream form or as an alcohol-based solution. Concentrations vary from a 2% concentration available in the United States without a prescription to a standard 4% concentration and even higher when compounded. Effectiveness is directly linked to concentration, but side effects also increase with concentration. It may reduce skin color too drastically, with some skin areas depigmented completely. If it is used inappropriately, hydroquinone can also cause a paradoxical and permanent darkening.

Azelaic acid
Azelaic acid, is as effective as 4% HQ and superior to 2% HQ in the treatment of melasma. Unlike HQ, azelaic acid seems to target only hyperactive melanocytes and thus will not lighten skin with normally functioning melanocytes. The primary adverse effect is skin irritation. No phototoxic or photoallergic reactions have been reported. Azelaic acid also has antimicrobial effect, which may be beneficial for those with acne.

Tretinoin
Tretinoin (Retin-A, Renova) is sometimes used alone or in combination with hydroquinone to treat melasma. It increases the turnover of skin cells, a process that helps reduce excess pigmentation. Tretinoin lightens melasma spots slowly, with improvement taking 6 months or longer. The major adverse effect is skin irritation, especially when the more effective, higher concentrations are used. Temporary photosensitivity and paradoxical hyperpigmentation can also occur.

Other depigmenting agents used for melasma treatment include phenolic-thioether, kojic acid, ascorbic acid, flavonoid extracts, and meladerm
Chemical peels
Chemical peels have become a popular method to treat melasma. A number of studies have shown that treating melasma with superficial chemical peels