Clear & even skin · 16 weeks
Melasma Care
A 16-week, no-bleach plan for melasma (brown-grey patches on the cheeks, forehead and upper lip), with visible-light protection, proven gentle actives and a doctor route.
- Length
- 16 weeks
- For
- Women, Men
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- Patches stop darkening: 2–4 weeks. Visible lightening: 8–12 weeks. Best result: 4–6 months. Relapse is common in sun and heat if protection lapses.
The goal: Lighter patches and fewer relapses. Melasma can be controlled, but it tends to return, so protection is lifelong.
Azelaic acid and doctor options graded A; tinted SPF, niacinamide and topical TXA B. Several trials included darker skin; some findings still need checking.
Start this program
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The plan
Weeks 1–2
Protect
Tinted SPF every day; stop triggers; patch-test your active.
Every active fails without daily UV and visible-light protection (Castanedo-Cázares RCT).
Morning
Gentle cleanse (or water rinse)
Lukewarm water; a 5-cent-coin amount of fragrance-free, soap-free cleanser; massage 30–60 seconds with fingertips; rinse; pat dry — never rub.
Why: Removes overnight oil and sweat without stripping the barrier lipids that keep water in.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Tinted sunscreen with iron oxides, SPF 30+ (50 if outdoors)
Two-finger rule for face and neck, every morning, including indoors near windows. Reapply every 2 hours outside or after sweating. Choose a shade that blends (many tints are too light for deep skin); if you cannot find one, put an iron-oxide tinted foundation or powder over a regular SPF.
Leave on: 15 min before sun
Why: Visible light worsens melasma in darker skin. In a double-blind RCT, a UV plus visible-light (iron-oxide) sunscreen gave more improvement than UV-only sunscreen. Safe in pregnancy.
Midday sunscreen top-up (if outdoors)
Blot sweat first, then pat on a fresh layer (one finger-length), or use an SPF powder over makeup.
Why: Sunscreen breaks down with sun and sweat; most people apply too little the first time.
Evening
Evening cleanse
If you wore sunscreen or makeup, cleanse twice (first pass loosens, second cleans). 60 seconds total per pass, lukewarm water, pat dry.
Why: Sunscreen and makeup left overnight can clog pores; a thorough but gentle cleanse prepares skin for treatments.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Habits
Patch test any new product
Apply a pea-size amount behind the ear or inner arm twice daily for 5–7 days before using on the face.
Why: Allergic reactions can take 48–72 hours to appear; testing a small area first prevents a full-face reaction.
Trigger review
List your hormonal contraception, fragranced or "toning" products, and any steaming, hot facials or long hours over a cooking fire. Ask your doctor whether a hormonal pill can be changed.
Why: Hormones, heat and irritation drive melasma; DermNet advises stopping hormonal contraception where possible.
Shade & hat
Wide-brim hat outdoors 10:00–16:00; seek shade; stay back from cooking fires and hot ovens where you can.
Why: Sun, visible light and heat all drive pigment, especially in melasma.
Check every pack for a NAFDAC number
Before buying, look for the NAFDAC registration number and an intact seal. Buy from a registered pharmacy, not a market table or social-media seller.
Why: Counterfeit and mislabelled creams are common; some "plain" creams secretly contain steroids, mercury or strong bleaching agents.
Voice of Nigeria: NAFDAC warns against high-hydroquinone skin creams (2025)
Weekly progress photo
Same place, same daylight by a window, no filter, no makeup; front, left and right.
Why: Change is slow; consistent photos show progress memory cannot.
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Weeks 3–10
Treat
Niacinamide in the morning; ONE evening active (azelaic acid by default).
Two well-tolerated actives act on different pigment steps; one evening active at a time limits irritation and dark marks.
Morning
Gentle cleanse (or water rinse)
Lukewarm water; a 5-cent-coin amount of fragrance-free, soap-free cleanser; massage 30–60 seconds with fingertips; rinse; pat dry — never rub.
Why: Removes overnight oil and sweat without stripping the barrier lipids that keep water in.
Niacinamide serum (4–5%)
Two to three drops pressed onto dry skin after cleansing, before moisturiser. In pregnancy or breastfeeding, ask your antenatal clinic first.
Why: In a double-blind RCT, niacinamide 4% lightened melasma with fewer side effects than hydroquinone.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Tinted sunscreen with iron oxides, SPF 30+ (50 if outdoors)
Two-finger rule for face and neck, every morning, including indoors near windows. Reapply every 2 hours outside or after sweating. Choose a shade that blends (many tints are too light for deep skin); if you cannot find one, put an iron-oxide tinted foundation or powder over a regular SPF.
Leave on: 15 min before sun
Why: Visible light worsens melasma in darker skin. In a double-blind RCT, a UV plus visible-light (iron-oxide) sunscreen gave more improvement than UV-only sunscreen. Safe in pregnancy.
Midday sunscreen top-up (if outdoors)
Blot sweat first, then pat on a fresh layer (one finger-length), or use an SPF powder over makeup.
Why: Sunscreen breaks down with sun and sweat; most people apply too little the first time.
Evening
Evening cleanse
If you wore sunscreen or makeup, cleanse twice (first pass loosens, second cleans). 60 seconds total per pass, lukewarm water, pat dry.
Why: Sunscreen and makeup left overnight can clog pores; a thorough but gentle cleanse prepares skin for treatments.
Azelaic acid 15–20% — your main evening active
On fully dry skin (wait 10 minutes after washing), a pea-size amount spread thinly over the patches and a little beyond. Every other night for 2 weeks, then nightly if comfortable; moisturiser on top after 5 minutes. Mild tingling is common. Suitable in pregnancy.
Leave on: 10 min on dry skin
Why: Cochrane found azelaic acid 20% more effective than hydroquinone 2%, and a 24-week RCT in skin types IV–VI showed it fades facial hyperpigmentation.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Habits
Option if azelaic acid irritates: cysteamine 5% (short-contact)
Use INSTEAD of azelaic acid, never together. Evening, dry skin, thin layer on patches; leave 15 minutes in week 1, then up to the time on the pack (usually 15–30 minutes); rinse, then moisturise. Warmth and redness are common; stop if it blisters. Not in pregnancy or breastfeeding. Mostly imported; check it is genuine.
Why: A meta-analysis of RCTs found cysteamine 5% better than placebo for melasma (small trials, Fitzpatrick III–V).
Option if azelaic acid irritates: tranexamic acid serum (2–5%)
Use INSTEAD of azelaic acid. Two to three drops or a pea-size amount on dry skin over the patches, once or twice daily, before moisturiser. Not in pregnancy or breastfeeding (no safety data).
Why: Tranexamic acid calms the blood-vessel and inflammation signals that switch on pigment cells; trials show modest benefit with little irritation (topical evidence is weaker than oral).
Hands off
No picking, squeezing or scrubbing spots; if tempted, cover with a hydrocolloid patch.
Why: Picking pushes inflammation deeper — the main cause of lasting dark marks and scars on darker skin.
Shade & hat
Wide-brim hat outdoors 10:00–16:00; seek shade; stay back from cooking fires and hot ovens where you can.
Why: Sun, visible light and heat all drive pigment, especially in melasma.
No scrubs, lemon, bleach or "toning" mixes
No scrubbing brushes, sponges, lime/lemon, toothpaste, bleach or mixed "caked" creams on the area.
Why: On darker skin, any irritation can leave a dark mark (post-inflammatory hyperpigmentation) that lasts months.
Weekly progress photo
Same place, same daylight by a window, no filter, no makeup; front, left and right.
Why: Change is slow; consistent photos show progress memory cannot.
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Weeks 11–16
Maintain
Keep tinted SPF and niacinamide; evening active 3–4 nights a week; doctor review if under a quarter better.
Melasma relapses when treatment and protection stop; a lower-intensity routine holds the result.
Morning
Gentle cleanse (or water rinse)
Lukewarm water; a 5-cent-coin amount of fragrance-free, soap-free cleanser; massage 30–60 seconds with fingertips; rinse; pat dry — never rub.
Why: Removes overnight oil and sweat without stripping the barrier lipids that keep water in.
Niacinamide serum (4–5%)
Two to three drops pressed onto dry skin after cleansing, before moisturiser. In pregnancy or breastfeeding, ask your antenatal clinic first.
Why: In a double-blind RCT, niacinamide 4% lightened melasma with fewer side effects than hydroquinone.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Tinted sunscreen with iron oxides, SPF 30+ (50 if outdoors)
Two-finger rule for face and neck, every morning, including indoors near windows. Reapply every 2 hours outside or after sweating. Choose a shade that blends (many tints are too light for deep skin); if you cannot find one, put an iron-oxide tinted foundation or powder over a regular SPF.
Leave on: 15 min before sun
Why: Visible light worsens melasma in darker skin. In a double-blind RCT, a UV plus visible-light (iron-oxide) sunscreen gave more improvement than UV-only sunscreen. Safe in pregnancy.
Midday sunscreen top-up (if outdoors)
Blot sweat first, then pat on a fresh layer (one finger-length), or use an SPF powder over makeup.
Why: Sunscreen breaks down with sun and sweat; most people apply too little the first time.
Evening
Evening cleanse
If you wore sunscreen or makeup, cleanse twice (first pass loosens, second cleans). 60 seconds total per pass, lukewarm water, pat dry.
Why: Sunscreen and makeup left overnight can clog pores; a thorough but gentle cleanse prepares skin for treatments.
Fragrance-free moisturiser
Apply within 3 minutes of patting dry, while skin is slightly damp: a 10-cent-coin amount for face and neck, pressed in, not rubbed hard.
Why: Humectants pull water into the outer layer; occlusives and ceramides seal it in, reducing transepidermal water loss.
Active nights
Azelaic acid 15–20% — your main evening active
On fully dry skin (wait 10 minutes after washing), a pea-size amount spread thinly over the patches and a little beyond. Every other night for 2 weeks, then nightly if comfortable; moisturiser on top after 5 minutes. Mild tingling is common. Suitable in pregnancy.
Leave on: 10 min on dry skin
Why: Cochrane found azelaic acid 20% more effective than hydroquinone 2%, and a 24-week RCT in skin types IV–VI showed it fades facial hyperpigmentation.
Habits
Doctor or dermatologist options (prescription only)Doctor or pharmacist
If patches are not at least a quarter lighter by week 12, ask a doctor about: a triple-combination cream (hydroquinone + tretinoin + a mild steroid) used for a limited, supervised course; prescription hydroquinone; or tranexamic acid tablets, after the doctor checks you have no clot risk. Never buy these from a market. Not in pregnancy or breastfeeding. Your doctor or pharmacist will advise the dose and how long.
Why: Cochrane found triple-combination cream more effective than hydroquinone alone; a meta-analysis shows oral tranexamic acid lowers melasma scores with mostly mild side effects. Supervision prevents ochronosis and steroid damage.
Rajaratnam et al. Interventions for melasma (Cochrane, 2010; CD003583) (verify)
Shade & hat
Wide-brim hat outdoors 10:00–16:00; seek shade; stay back from cooking fires and hot ovens where you can.
Why: Sun, visible light and heat all drive pigment, especially in melasma.
Weekly progress photo
Same place, same daylight by a window, no filter, no makeup; front, left and right.
Why: Change is slow; consistent photos show progress memory cannot.
No scrubs, lemon, bleach or "toning" mixes
No scrubbing brushes, sponges, lime/lemon, toothpaste, bleach or mixed "caked" creams on the area.
Why: On darker skin, any irritation can leave a dark mark (post-inflammatory hyperpigmentation) that lasts months.
Food
Hydration
Water with each meal and whenever thirsty; more in heat and harmattan.
Why: Supports overall health; skin hydration is mostly about the barrier, so pair water with moisturiser.
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
- Stinging, burning, peeling or new rash this week?None / Mild, settled in minutes / Lasting or spreading / Swelling or blisters
- Compared with last week, the main concern is…Worse / Same / A little better / Clearly better
- Days you used tinted SPF0–2 / 3–4 / 5–6 / 7
- Patches turning blue-grey, darker after a cream, or new gritty bumps in the patches?No / Yes
Stop and see a doctor if
- Blue-grey or gritty "caviar" bumps in the patches (possible exogenous ochronosis from hydroquinone): stop the cream and see a doctor
- Burning, peeling or swelling that lasts more than a day
- Never use "toning", "carrot", mercury or steroid creams, or whitening injections
- Patches that are raised, itchy, scaly or on the body (may be something else; see a doctor)
- On tranexamic acid tablets: leg swelling or pain, chest pain or breathlessness: urgent care
In an emergency, call 112112999911911.
Sources
- AAD: Sunscreen FAQs
- Lyons et al. Visible light & tinted sunscreens, JAAD 2021
- Castanedo-Cázares et al. Near-visible light and UV photoprotection in melasma: double-blind RCT (Photodermatol Photoimmunol Photomed, 2014) (verify)
- Visible-light-protective tinted vs untinted sunscreen in melasma during summer: randomised investigator-blinded study (2025) (verify)
- Rajaratnam et al. Interventions for melasma (Cochrane, 2010; CD003583) (verify)
- Lowe et al. Azelaic acid 20% cream for facial hyperpigmentation in darker-skinned patients (Clin Ther, 1998)
- Navarrete-Solís et al. Niacinamide 4% vs hydroquinone 4% for melasma: double-blind RCT (Dermatol Res Pract, 2011) (verify)
- Cysteamine 5% cream for melasma: systematic review and meta-analysis of RCTs (Arch Dermatol Res, 2024) (verify)
- Kim et al. Tranexamic acid in melasma: meta-analysis and systematic review (Acta Derm Venereol, 2017)
- Liang et al. Tranexamic acid for melasma by administration route: SR & network meta-analysis (J Cosmet Dermatol, 2024) (verify)
- DermNet: Melasma
- Latin American consensus on the treatment of melasma (2024) (verify)
- MotherSafe (Royal Hospital for Women): Skin and hair treatments in pregnancy and breastfeeding (2021)
- DermNet: Postinflammatory hyperpigmentation
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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