Melasma Treatment

Most melasma treatments take a fixed, generic approach to a condition that is hormonal, chronic and prone to coming back. We don’t. After a consultation with a doctor, we design a topical cream using prescription-strength ingredients chosen for your skin. Your treatment targets your melasma pattern and depth, your skin tone and your skin’s sensitivity, alongside any other concerns you have. The same doctor looks after you throughout and adjusts each course based on how your skin responds. And because everything happens online, your treatment is designed and delivered without you leaving your home.

Step 1
Choose a form or video consultation with your doctor.

Step 2
Treatment plan with a cream designed for you.

Step 3
Follow-up to refine your treatment plan and reduce side effects.

Understanding Melasma

Melasma is a chronic form of hyperpigmentation that causes darker, often symmetrical patches. It is most common on the cheeks, forehead, bridge of the nose, chin and upper lip. It develops when the skin overproduces melanin (the pigment that gives skin its colour), usually through a combination of hormones, sun exposure and genetics. Hormonal triggers include pregnancy, where it’s sometimes called chloasma or the mask of pregnancy, as well as contraceptive use and menopause. Sun exposure both triggers melasma and makes it worse, which is why sun protection is essential throughout treatment.

Melasma tends to develop gradually and appears as flat, blotchy patches rather than defined spots. It is more common in women, though men get it too, and it is especially common in medium and deeper skin tones. Unlike a dark mark that fades and stays gone, melasma can return. So ongoing management works better than a one-off treatment, and that shapes how we design yours.

Why a Treatment Built for Your Melasma Works Better

Melasma isn’t one condition. It varies in depth, pattern, triggers and how it responds to treatment. So someone with superficial melasma on lighter skin needs a very different formula from someone with deeper melasma on darker skin, where an aggressive treatment can irritate the skin into producing more pigment and make the patches worse. A treatment that works well for one person can underperform or backfire for another. That’s why we build every prescription-strength treatment around you and review it at the end of each course. Your doctor can increase, reduce or swap ingredients based on what is actually happening with your skin, rather than keeping you on a standard formula that may not be working.

Melasma Treatments at City Skin Clinic

Your cream is built around four things: the pattern and depth of your melasma, your skin tone, your medical history and what you want to change. Two people with melasma will rarely get the same formula. After your consultation, your doctor designs your treatment, then refines it at the end of each course, taking your wishes and preferences into account as much as possible. There are two protocols, depending on what your skin needs:

• MLS: A single once-a-day treatment cream. It’s our standard protocol for mild to moderate melasma, and for maintaining results once your melasma has improved. Depending on the ingredients your doctor selects, MLS can also support overall skin tone, texture and ageing.
• MLS+: A two-product protocol, one for morning and one for evening, for more severe or resistant melasma. It gives more intensive coverage and is typically used for a defined period of up to 6 months before stepping down to MLS for maintenance.

Your doctor will recommend the right pathway at your consultation and can move you between protocols at the end of each course as your skin improves.

There is no subscription and no auto-renewal. Each course is a single order you place yourself.

Treating Melasma on the Face and Neck

Melasma most commonly affects the face, particularly the cheeks, forehead, nose and upper lip. It can also appear on the neck, either on its own or together with the face, and we treat both. Your doctor will design your treatment around the more delicate skin of these areas, which is prone to irritation that can worsen melasma. They will choose ingredients and strengths that are effective but gentle enough for use on the face and neck.

Not every dark patch on the neck or lower face is melasma. Chronic sun exposure can also cause poikiloderma of Civatte, which combines brown discolouration with redness and fine visible vessels in a lacy pattern along the sides of the neck, typically sparing the shaded area under the chin. Melasma tends to form flat brown patches without the redness, though the two can occur together on sun-exposed skin. If your doctor suspects poikiloderma, they will design your treatment accordingly. A prescription cream can help fade the pigmented element, using strengths suited to the thinner skin of the neck. However, the redness and thread veins respond poorly to creams. These usually need in-person light or laser treatment, which we don’t offer.

Melasma Treatment for All Skin Tones

We treat melasma across all skin tones and design each treatment to take this into account. Melasma is especially common in medium and deeper skin tones, where the stakes of getting treatment wrong are higher. Harsh or poorly matched actives can irritate the skin into producing more pigment, leaving patches darker than before. That risk shapes how your doctor builds your formula. They choose ingredients, strengths and frequencies to suit your skin rather than defaulting to the strongest option. Even Hydroquinone and Tretinoin can be used in deeper skin tones under this kind of supervision. They may also add calming ingredients like Hydrocortisone or Niacinamide. Your doctor then reviews how your skin responds at the end of each course, adjusting your formula based on what they see.

Ingredients in Our Melasma Treatments

Every formula is built for you and can be adjusted at the end of each 3-month course. We choose ingredients to target the specific drivers behind your melasma, protect against further darkening and support your skin’s overall health. As much as possible, your doctor will also take your wishes and preferences into account. These are some of the active ingredients we may use in our melasma treatment creams:

• Tretinoin: A prescription retinoid we may use alone or with other ingredients in our melasma creams. It speeds up skin cell turnover to help fade pigmentation, smooth texture and improve overall skin tone. It needs careful monitoring, particularly in darker skin tones where irritation can itself trigger further pigmentation, as it’s up to 20 times more powerful than retinol.
• Hydroquinone: A prescription depigmenting agent widely regarded as the benchmark for stubborn pigmentation. It works by suppressing melanin production, and your doctor may include it for limited periods, in courses with breaks, in suitable patients when melasma is the dominant concern. It’s suitable for all skin tones under your doctor’s supervision.
• Tranexamic acid: Reduces pigmentation by calming the signals that drive melanin-producing cells to overproduce. It’s particularly effective for melasma and works best alongside other actives in your formula.
• Azelaic Acid: Has antibacterial, anti-inflammatory and keratolytic (skin-renewing) properties. It fades uneven pigmentation whilst calming inflammation, which makes it useful where melasma sits alongside redness or sensitivity, with a lower irritation risk than many alternatives.
• Niacinamide: Reduces redness and inflammation, helps even out skin tone and strengthens the skin barrier. Niacinamide works well alongside stronger depigmenting actives to support tolerability without adding harshness.
• Hydrocortisone: A mild corticosteroid that reduces inflammation and soothes irritated skin. We sometimes use it in the early stages to help skin adjust to active ingredients without excessive irritation. This matters with melasma, where irritation itself can deepen pigmentation.

All prescription ingredients are used in our melasma creams only where your doctor judges them safe, appropriate and suitable for you.

How Long Does Melasma Treatment Take to Work?

Some patients may notice early improvement after 8 to 12 weeks, with more meaningful fading developing over 3 to 6 months or longer. Melasma is one of the slower forms of hyperpigmentation to respond, because the pigment often sits deeper in the skin and the hormonal and environmental triggers behind it are ongoing. It is not a quick fix. How long hyperpigmentation treatments take to work sets out the typical response pattern for each ingredient. Your doctor will set realistic expectations for your melasma at your consultation and throughout your treatment.

Because melasma is a chronic condition, maintenance treatment is usually necessary even after your skin has improved. Your doctor will work with you on a sustainable long-term plan. In the first few weeks, some treatments can cause an adjustment phase, which may include mild dryness, irritation or temporary sensitivity. This is a recognised part of the process and one of the reasons we start at a strength and frequency suited to your skin rather than pushing maximum intensity from day one. Sun protection is essential throughout. UV exposure is one of the main triggers of melasma and can reverse progress or cause rebound darkening, particularly when using ingredients like Tretinoin or Hydroquinone.

Why We Focus on Custom Topical Melasma Treatments

Topical treatment is the gold standard first-line approach for melasma. A custom topical treatment lets us combine several depigmenting and skin-improving ingredients in one formula, target them directly to the affected area and adjust the balance at the end of each course. For most patients, a well-designed topical treatment delivers meaningful improvement with lower risk than procedures like chemical peels or laser, which can themselves worsen melasma in susceptible skin tones. Our service centres around topical prescription treatment. If your melasma isn’t responding adequately, your doctor will discuss this with you and may suggest other options, including in-person treatment, which we don’t offer.

Who Is Suitable for Online Melasma Treatment?

We treat melasma across all skin tones and patterns. This service may be right for you if you:

• Have melasma on the face (cheeks, forehead, nose, chin or upper lip) or on the neck
• Have hormonal melasma linked to contraception, menopause or a past pregnancy
• Have melasma that hasn’t responded well to over-the-counter products
• Have a deeper or more sensitive skin tone and want treatment designed with that in mind
• Want a structured treatment plan with ongoing doctor follow-up, not a one-off prescription
• Prefer prescription-strength treatment delivered to your home, wherever you are in the UK

Our melasma treatment is for adults aged 18 and over. If your melasma isn’t responding to topical treatment or needs further investigation, your doctor may recommend an alternative approach, including a more suitable service.

If you’re pregnant or breastfeeding, let your doctor know at your consultation. Most of the strongest melasma actives, including Hydroquinone and Tretinoin, aren’t suitable at that time. Your doctor will design a formula around ingredients that are safe and leave out anything that isn’t. Melasma that first appears in pregnancy may also fade on its own in the months after giving birth. So your doctor may talk through whether to treat now or wait.

Why Choose City Skin Clinic

We don’t believe in generic, fixed-formula treatment. Every treatment is prescribed by a doctor, built around your skin and adjusted at the end of each course based on how you respond, so your treatment evolves with you rather than staying the same. That standard of care is what sets us apart from other melasma treatment services:

• Doctor-led care from day one: Your treatment starts with either a detailed form consultation or an in-depth video consultation with one of our doctors, whichever suits you. Your doctor reviews your concerns, assesses your skin and designs a plan that’s unique to you.
• Genuinely personalised: Your treatment is built around your melasma pattern, your skin tone and your skin’s sensitivity. It’s adjusted at the end of each course based on how your skin responds.
• Ongoing follow-up: After your consultation, you can email your prescribing doctor at any time for advice, a progress review and your next course.
• Delivered to your door: Your treatment arrives at your home with a clear plan, and aftercare is unlimited and included.

From your first consultation onwards, the same doctor designs your treatment, follows your progress and adjusts your formula as your skin changes.