Melasma causes brown or greyish-brown patches, most often on the cheeks, forehead, nose and upper lip. It isn’t harmful, but it can be frustrating: it tends to be stubborn, and it often returns after treatment. The good news is that with the right combination of sun protection and proven topical treatments, most people can significantly lighten their patches. This guide explains what causes melasma and how the most effective melasma treatment creams work.

What Causes Melasma?

Melasma happens when the pigment-producing cells in the skin (melanocytes) become overactive. The main triggers are:

• Sun exposure: ultraviolet (UV) and visible light are the biggest drivers, and even short daily exposure counts.
• Hormones: pregnancy (melasma is sometimes called “the mask of pregnancy”), the contraceptive pill and hormone therapy.
• Genetics: it often runs in families.
• Skin type: it is more common in women and in people with medium to darker skin tones.
• Heat and some cosmetics, which can make it worse.

Step 1: Sun Protection (The Non-Negotiable)

No cream will work well without strict sun protection. Even brief sun exposure can undo weeks of progress.

• Use a broad-spectrum sunscreen, SPF 30–50, every morning, all year round, indoors and out.
• Choose a tinted sunscreen containing iron oxides where possible. It also blocks visible light, which ordinary sunscreens don’t.
• Reapply every 2 hours when outdoors.
• Wear a wide-brimmed hat and seek shade between 10am and 4pm.

Step 2: Hydroquinone Creams

Hydroquinone has long been one of the most widely used topical treatments for melasma. It works by blocking tyrosinase, the enzyme the skin needs to make melanin, which gradually lightens dark patches.

• Common strengths are 2% and 4%.
• Improvement usually becomes visible after 4–12 weeks.
• It is typically used for about 3–4 months, followed by a break. Long-term continuous use can, rarely, cause a bluish-black darkening called exogenous ochronosis.
• Mild redness, dryness or stinging can occur. Do a patch test on a small area first.

Hydroquinone creams include Melalite Forte Cream, Eukroma Cream and Melanorm Cream.

Step 3: Triple Combination Creams

For moderate to stubborn melasma, dermatologists often prescribe a triple combination cream. It combines three ingredients that work together:

1. Hydroquinone: reduces melanin production
2. Tretinoin: speeds up skin cell turnover, so pigmented cells are shed faster and hydroquinone penetrates better
3. A mild corticosteroid (such as mometasone or fluocinolone): calms the irritation the other two can cause

Triple combination therapy is considered one of the most effective topical treatments for melasma. An example is Melacare Cream (hydroquinone, tretinoin and mometasone).

Because these creams contain a steroid, they are usually used for a limited period, often up to 8 weeks, as directed by a doctor. Longer use can cause skin thinning, visible blood vessels, acne-like breakouts or stretch marks.

How to Apply Melasma Creams

1. Cleanse gently and pat the skin completely dry.
2. Apply a thin layer only to the dark patches, once daily at night, unless told otherwise.
3. Avoid the eyes, lips and corners of the nose.
4. Wash your hands afterwards.
5. Apply sunscreen every morning without exception.

Gentler Options and Maintenance

Melasma often comes back, especially after sun exposure or hormonal changes. Once your patches have improved, a doctor may switch you to a gentler maintenance routine, such as:

• Azelaic acid (for example Aziderm 20% cream): lightens pigment and is often considered suitable in pregnancy
• Niacinamide, vitamin C, kojic acid or tranexamic acid serums
• Continued daily tinted sunscreen

In-clinic treatments such as chemical peels may also help, but some lasers can make melasma worse, so choose an experienced dermatologist.

Who Should Be Careful

Avoid hydroquinone and tretinoin if you are pregnant or breastfeeding. Melasma that appears during pregnancy often fades on its own after delivery. See a doctor first if you are unsure whether a patch is melasma. Other conditions, including some skin cancers, can look similar and should be checked.

Frequently Asked Questions

Can melasma be cured permanently?

Melasma can be greatly improved and sometimes cleared, but it tends to recur. Long-term sun protection and a maintenance routine are the best ways to keep it away.

How long does it take for melasma creams to work?

Most people notice lightening within 4–8 weeks, with more significant results by around 12 weeks.

Why is my melasma getting darker during treatment?

Usually this is due to sun or heat exposure, or irritation from the cream. Review your sunscreen routine and speak to your doctor if the skin becomes very red or inflamed.

Browse our full range of melasma treatments, or read our guide to using tretinoin for tips on reducing irritation.

This article is for general information only and is not a substitute for professional medical advice. Consult a doctor or dermatologist for diagnosis and before using prescription skin-lightening treatments.

Tretinoin is one of the most effective and well-studied topical treatments for acne. Dermatologists have prescribed it for over 50 years. It can clear blackheads and whiteheads, reduce breakouts, and even improve post-acne marks and fine lines. It also has a reputation for causing dryness and peeling in the first few weeks, which is why so many people give up too early. This guide explains how tretinoin for acne works, which strength to start with, and how to use it for the best results with the least irritation.

What Is Tretinoin?

Tretinoin (also known as all-trans retinoic acid) is a topical retinoid, a form of vitamin A applied directly to the skin. It is available as a cream or gel on prescription, and is sold under brand names such as Retin-A, as well as generics like Tretinoin cream and Tretoin gel.

How Tretinoin Treats Acne

Acne starts when dead skin cells and oil block a pore, forming a microcomedone that can become a blackhead, whitehead or inflamed spot. Tretinoin works on this root cause:

• Speeds up skin cell turnover, so dead cells don’t build up and clog pores
• Unblocks existing comedones (blackheads and whiteheads)
• Prevents new blockages from forming
• Reduces inflammation and helps other acne treatments penetrate better
• Fades dark marks left by old spots and improves skin texture over time

Which Tretinoin Strength Should You Use?

Creams are generally more moisturising and gentler. Gels suit oilier skin but can feel more drying. Most dermatologists recommend starting low and increasing gradually. A higher strength isn’t necessarily better if it leaves your skin too irritated to use consistently.

How to Use Tretinoin: Step by Step

1. Apply at night only. Tretinoin breaks down in sunlight and makes skin more sun-sensitive.
2. Cleanse gently with a mild, non-foaming cleanser and pat dry.
3. Wait 20–30 minutes until your skin is completely dry. Applying to damp skin increases irritation.
4. Use a pea-sized amount for your whole face. Dot it on the forehead, cheeks and chin, then spread thinly. More is not better.
5. Avoid sensitive areas: the corners of the nose, the eyes and the lips.
6. Moisturise with a simple, fragrance-free moisturiser, before or after tretinoin.
7. Use sunscreen every morning: broad-spectrum SPF 30 or higher, even on cloudy days.

Start with two or three nights a week, then increase to every other night and eventually nightly as your skin adjusts.

What to Expect: The Tretinoin Timeline

• Weeks 1–4: Dryness, flaking, redness and mild stinging are common while the skin adjusts (sometimes called “retinisation”). Some people get a temporary flare of breakouts as clogged pores come to the surface (“purging”).
• Weeks 6–8: Irritation usually settles and fewer new spots appear.
• Weeks 12 and beyond: Clearer skin, fewer blackheads and faded marks. Full results can take 3–6 months.

Patience is the key to success. Most people who say tretinoin “didn’t work” stopped before the 12-week mark.

What Not to Combine With Tretinoin

• Harsh scrubs, exfoliating acids (AHA/BHA) and toners with alcohol. These can seriously increase irritation.
• Benzoyl peroxide at the same time. It can break down some tretinoin formulas. If both are prescribed, use benzoyl peroxide in the morning and tretinoin at night.
• Waxing on treated skin. It can lift the skin.

Who Should Not Use Tretinoin

Avoid tretinoin if you are pregnant, trying to conceive or breastfeeding, unless a doctor specifically advises otherwise. Don’t apply it to sunburned, broken or eczema-affected skin. Other prescription retinoids such as tazarotene (Tazret gel) must also be avoided in pregnancy.

What If Tretinoin Isn’t Enough?

For moderate acne, doctors often combine tretinoin with a topical antibiotic or benzoyl peroxide. Azelaic acid (such as Aziderm 20% cream) is a gentler alternative that also helps with dark marks. Severe, scarring or cystic acne may need oral treatment such as isotretinoin. That medicine requires specialist supervision, regular monitoring and strict pregnancy prevention, so it should only be started by a dermatologist.

Frequently Asked Questions

Can I use tretinoin every night from the start?

Most people can’t without significant irritation. Starting two or three nights a week and building up is far more sustainable.

Does tretinoin help acne scars?

It can fade dark marks (post-inflammatory hyperpigmentation) and mildly improve texture over months. Deep, pitted scars usually need procedures such as microneedling or laser treatment.

Is tretinoin the same as retinol?

No. Retinol is a weaker, over-the-counter ingredient that the skin must convert into retinoic acid. Tretinoin is already the active form, making it considerably stronger and more effective for acne.

Explore our complete acne treatment range and other skin care products.

This article is for general information only and is not a substitute for professional medical advice. Speak to a doctor or dermatologist before starting a prescription skin treatment.