- Why it Relapses: Melasma isn't just surface pigment; it is often "fed" by underlying inflammation and abnormal blood vessels (vascular melasma).
- The "Gold Standard" Creams: Hydroquinone (Prescription-Only) is for short-term clearing; Cysteamine is the safe alternative for long-term maintenance.
- The "Internal" Fix: Oral Tranexamic Acid is highly effective for hormonal cases but requires medical screening for blood clot risks.
- Lasers: Pico Laser shatters pigment without heat, while Yellow Laser and Sylfirm X target the underlying blood vessels and basement membrane to prevent recurrence.
“Glass skin” gets all the hype, but for most people, the real goal is clear, even-toned skin. Melasma, with its persistent brown or grey-brown patches, can feel especially discouraging. Unlike sunspots or acne marks, it’s triggered by a mix of factors, and so it often resists basic skincare.
In fact, treating Melasma like a regular sun spot (using high-heat lasers) is the fastest way to make it worse.
To get real results in Singapore’s sunny climate, you need to stop treating just the “stain” and start treating the root causes. Here is the medically accurate breakdown of what works.
Melasma Treatment: Why It’s So Stubborn & What Actually Works
Melasma is a form of hyperpigmentation triggered by excess melanin production. It’s more common in women, especially those with medium to darker skin tones (Fitzpatrick types III to V), and tends to appear between the ages of 20 and 40.
Dermatologists now understand that stubborn Melasma is often maintained by three deeper factors:
- Vascular Activity: Abnormal blood vessels underneath the dark patch "feed" the pigment cells (melanocytes) with inflammatory signals.
- Weak Basement Membrane: The "floor" of your upper skin is damaged, allowing pigment to drop deep into the dermis (dermal melasma), where creams cannot reach.
- Hormonal Triggers: Estrogen and stress stimulate pigment production from the inside.
Because melasma involves the deeper layers of the skin, it’s often resistant to basic skincare or over-the-counter brightening products. To get real results in Singapore’s sunny climate, you need to stop treating just the “stain” and start treating the root causes.
This is why targeted treatment, under a dermatologist’s guidance, is crucial. Book a consultation at DermAlly today.
1. Medical-Grade Topicals (The First Line of Defence)
Store-bought whitening creams are rarely strong enough for Melasma. You typically need prescription-strength agents to “shut down” the pigment factory.
- Hydroquinone (The Prescription Standard)
- How it works: It is a potent tyrosinase inhibitor that stops melanin production.
- Singapore Safety Warning: Hydroquinone is a Prescription-Only Medicine (POM). It is illegal in over-the-counter cosmetics. It must only be used for short cycles (3 - 4 months). Misuse or long-term use can cause Exogenous Ochronosis, a permanent blue-black skin discolouration that is extremely difficult to treat.
- Cysteamine (The Safe Long-Term Alternative)
- How it works: A newer medical-grade cream that reduces pigment effectively without the toxicity risks of Hydroquinone. It is safe for long-term maintenance, making it a preferred choice for preventing relapse.
2. Oral Medication: Treating From the Inside
If your Melasma is widespread or hormonal in nature, creams alone may fail.
Oral Tranexamic Acid
Originally a medicine to stop bleeding, it was accidentally discovered to clear Melasma by reducing the vascular inflammation that triggers pigment.
Because it affects blood clotting, it is not suitable for patients with a history of thrombosis (blood clots) or stroke, or for those taking certain blood thinners. Please contact our team and speak to our dermatologists to find out what treatment option is most suitable for your case.
3. Hormone & Stress Management
Because internal triggers like hormones and stress can worsen melasma, treatment often includes lifestyle and health adjustments. Managing birth control, treating thyroid issues, or supporting your stress response with proper sleep and skincare can make a big difference.
4. Laser Treatments for Melasma
At DermAlly, we use a combination of technologies to treat Melasma:
Pico Laser (For Shattering Pigment)
Best For: Breaking down visible brown pigment.
Why It’s Safer: Unlike older lasers that use heat (which can trigger “rebound” melasma), Pico lasers use photoacoustic (sound) energy. This shatters the pigment into dust-like particles without overheating the skin, significantly reducing the risk of Post-Inflammatory Hyperpigmentation (PIH) in Asian skin.
Yellow Laser (For the "Red" Component)
Best For: Melasma that looks reddish or has visible underlying veins.
The Mechanism: The Yellow Laser (577nm) specifically targets the abnormal blood vessels feeding the melasma. By reducing this vascular supply, we “starve” the pigment, making relapse less likely.
RF Gold Microneedling (For Repair)
Best For: Strengthening the skin to prevent pigment from dropping deeper.
The Mechanism: Uses pulsed radiofrequency to repair the basement membrane (the junction between skin layers). A stronger membrane prevents pigment from leaking into the deeper dermis.
Comparison: Which Treatment Do You Need?
| Treatment | Best For… | Key Medical Benefit | Downtime |
| Hydroquinone | Rapid initial clearing | Strongest pigment suppression | Mild Redness |
| Cysteamine | Long-term maintenance | Safe for unlimited use (No Ochronosis risk) | None |
| Oral Tranexamic Acid | Hormonal/Vascular Melasma | Treats internal triggers | None |
| Pico Laser | Visible Brown Spots | Shatters pigment without heat risk | 1–2 Days (Pink) |
| Yellow Laser | “Red” Melasma (Vascular) | Cuts off the blood supply to the pigment | None |
Struggling with relapse? You might have untreated vascular melasma. Book a specialised diagnostic assessment at DermAlly to find the root cause.
Are These Treatments Suitable for You? Speak to a Dermatologist Today
At DermAlly, we assess your skin type, pigmentation depth, and lifestyle to create a personalised melasma treatment plan. If you’re tired of covering up or trying products that don’t work, let’s talk. With patience and expert care, clearer, more even-toned skin is possible.
Frequently Asked Questions (FAQ)
Can Melasma be cured completely?
Medically speaking, no. Melasma is a chronic condition, similar to eczema or diabetes. There is no permanent “cure,” but it can be managed to the point where it is barely visible. The goal is “clearance and control,” not just removal.
Why does my melasma get darker over time without treatment?
Melasma is triggered by both UV rays and Heat. Even if you wear sunscreen, the heat from the sun (or even cooking and saunas) can stimulate your pigment cells. We recommend keeping your skin cool and using physical blockers (hats/umbrellas).
How fast does Oral Tranexamic Acid work?
Many patients see a significant reduction in redness and pigment within 8 to 12 weeks of daily use. It is often prescribed as a 3–6 month course.
Our articles are written and reviewed by Dr. Coni Liu (MRCS, FAMS) and Dr. Heng Jun Khee (MRCP, FAMS), Ministry of Health-accredited Consultant Dermatologists at DermAlly.
Both are Fellows of the Academy of Medicine (Dermatology) and previously served as Consultants at the National Skin Centre (NSC), bringing extensive experience in medical, surgical, and aesthetic dermatology. They are committed to making expert-led skin education accessible, practical, and clear, helping patients look and feel their best through evidence-based care rooted in science and compassion.
