Effective strategies for melasma treatment include prescription topicals and oral medication along with oral supplements. Combinations of hydroquinone, tretinoin, azelaic acid and steroid cream in varying concentrations and percentages are standard melasma treatments, resulting in significant improvement. Non-prescription lightening agents, like vitamin A and C, kojic acid, and niacinamide, show benefits for melasma skin discoloration and can be used without a prescription. Sun protection with SPF 50 or higher and use of tinted sunscreens are essential for prevention and maintenance. 

Cyclical use of prescriptions, natural remedies and chemical peels can prevent and maintain results.  At home peels with alpha hydroxy acids, lactic and salicylic acids are very helpful. 

Oral tranexamic acid is very effective for melasma and is best used for resistant melasma, although not all patients are candidates for this treatment.  Oral supplementation with licorice extract, beta-carotene, astaxanthin, and polypodium leucotomos, can reduce damaging effects of the sun and optimize results.