TL;DR: Melasma is a chronic pigmentation disorder driven by hormones (estrogen, progesterone), UV exposure, heat, and genetic predisposition. It affects the deeper dermal layer of skin, making it resistant to superficial treatments. Unlike sun spots, melasma can recur after treatment and requires ongoing management rather than a one-time cure.
Written by Dr. Waleerat Thaweebanchongsin, licensed aesthetic medicine specialist with over 10 years of specialized experience in pigmentation management. VERZO CLINIC near BTS Ekkamai, Sukhumvit Road. Free consultations via LINE @verzo.
Last updated: April 2026
Melasma is a chronic pigmentation disorder driven by hormones (estrogen, progesterone), UV exposure, heat, and genetic predisposition. It affects the deeper dermal layer of skin, making it resistant to superficial treatments. Unlike sun spots, melasma can recur after treatment and requires ongoing management rather than a one-time cure.
The approach targets melasma from two angles. Pico laser with 1064nm MLA breaks up existing pigment deposits with minimal inflammation. Oral tranexamic acid reduces melanin synthesis systemically. Combined with daily SPF50+ and a topical prescribed at consultation, this works faster and holds longer than laser alone.
Melasma cannot be permanently cured — it is a chronic condition that can be managed to near-invisible levels. With the right protocol, patients achieve 70-90% improvement. Maintenance treatments every 2-3 months and strict sun protection are essential to prevent recurrence.
Oral tranexamic acid at 250-500mg twice daily has been extensively studied for melasma with a good safety profile. It is not recommended for patients with history of blood clots, stroke, or those taking hormonal contraceptives. Dr. Waleerat screens patients before prescribing.
Initial improvement is typically visible within 4-6 weeks. Significant improvement occurs over 3-6 months of consistent treatment. The combination protocol accelerates results compared to topical treatment alone. Monthly progress photos help track improvement.
Strict SPF50+ sunscreen reapplied every 2-3 hours, wearing a hat and sunglasses outdoors, avoiding heat exposure (hot yoga, saunas), managing stress, and reviewing hormonal medications with your doctor. Sunscreen is the single most important factor in melasma management.
The combination protocol typically costs 5,000-15,000 THB per session depending on components used. A typical 6-session program ranges from 30,000-90,000 THB. This covers the pico laser sessions and the tranexamic acid course. The exact protocol is set at consultation, since melasma depth and triggers differ between patients.
Yes. The protocol suits all skin types including Fitzpatrick IV-VI. The pico laser at 1064nm with low fluence minimizes the risk of post-inflammatory hyperpigmentation, which is the main concern when treating pigmentation in darker skin, and tranexamic acid works systemically rather than on the skin surface.
VERZO CLINIC — 988-990-992 Sukhumvit Road, Ekkamai, Bangkok 10110, Thailand. 每日 10:00–19:00（泰國時間）營業。 可提供泰語、英語、日語和中文服務。
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