How do I know which kind I have?

You mostly cannot from a photograph, and that is why the first consultation question matters more than the device on offer. Melasma is patterned, symmetrical facial pigment driven by sun and hormones. Post-inflammatory marks follow a spot or a procedure and fade on their own. Sun spots are discrete and sun-exposed. Dermal pigment sits deeper and responds differently again. Ask your clinic to name yours before anything is switched on.

Does laser work for melasma?

One kind does. Across 52 randomised trials, low-fluence Q-switched Nd:YAG significantly beat controls (MD 1.47; 95% CI 0.08–2.85) while picosecond lasers did not (MD −0.11; 95% CI −0.79 to 0.57). The overall pooled analysis was a non-significant trend. Lasers in this field are described by the reviewers as adjunctive tools, not a cure.

What is tranexamic acid?

A prescription medicine, originally an antifibrinolytic, now widely used for melasma. In a network meta-analysis, oral tranexamic acid combined with routine topical agents produced the largest reduction in melasma severity at weeks 4, 8 and 12 and at last follow-up — ahead of intradermal, topical and microneedled delivery. A separate meta-analysis of 22 studies and 1,280 patients found the same ranking.

Is oral tranexamic acid safe?

The published reviews describe it as generally well tolerated, with gastrointestinal upset, menstrual irregularity, headache and skin irritation as the reported effects, and no major thromboembolic events across the studies reviewed. They also stress proper screening for contraindications and cautious patient selection — which is the reason this is a conversation with a doctor who knows your history, not a purchase.

Does sunscreen actually make a difference?

More than any single procedure, and it is the only intervention here with a long randomised trial behind it. In a 4.5-year randomised community trial of 903 adults in Queensland, the daily sunscreen group showed no detectable increase in skin aging, with 24% less aging than the discretionary-use group.

Concerns · also called hyperpigmentation, 색소침착, melasma

Pigmentation: four different problems that share one word

Four different problems get called pigmentation, and they need different treatment. The best-evidenced melasma option is a tablet plus a cream, not a laser.

Author: Aesthetics Korea Editorial Team
Medical review: Reviewed by 2 doctorsSee methodology
Published: 8 September 2026
Last updated: 8 September 2026
Last reviewed: —6 min read

Short answer

"Pigmentation" covers at least four different problems — melasma, post-inflammatory marks, sun spots, and dermal pigment — and treating the wrong one is the most common and most expensive mistake in this category. For melasma specifically, the strongest pooled evidence is not for a laser: it is for oral tranexamic acid combined with topical treatment, and everything recurs without daily sun protection.

Key facts

Not one condition: Melasma, post-inflammatory hyperpigmentation, sun spots, and dermal pigment behave differently
Best-evidenced for melasma: Oral tranexamic acid plus routine topicals beat every other route in a network meta-analysis
Lasers: Low-fluence Q-switched Nd:YAG worked across 52 RCTs; picosecond lasers did not beat controls
Peels: Effective as single agents in darker skin, with glycolic acid ahead of trichloroacetic acid
Prevention: Daily sunscreen users showed no detectable increase in skin aging across 4.5 years
The honest framing: Melasma is managed, not cured. Recurrence after stopping is the expected case

Four problems, one word

Almost every wasted course in this category comes from treating the wrong one.

Melasma. Patterned, usually symmetrical facial pigment, driven by ultraviolet light and hormones. Chronic. It recurs.

Post-inflammatory hyperpigmentation. The brown mark left behind by a spot, a burn, or a procedure. It fades on its own, given time and sun protection.

Sun spots and freckles. Discrete, in sun-exposed places, from accumulated ultraviolet damage. The most straightforwardly treatable of the four.

Dermal pigment. Deeper pigment, including the bilateral patches often confused with melasma. It sits at a different depth and answers to different settings.

These look alike in a mirror and behave completely differently under treatment. So the first question at a consultation is not which laser — it is which of these do I have, and in what proportion? A clinic that quotes a package before answering that has not assessed you.

What actually has the best evidence for melasma

Not a device. This is the finding most clinic menus have no reason to tell you.

A network meta-analysis compared routes of tranexamic acid for melasma. Oral tranexamic acid combined with routine topical agents produced a greater reduction in melasma severity than intradermal injection, topical application, or microneedled delivery — at weeks 4, 8 and 12 and at last follow-up. Oral also acted faster than every other route.

A separate meta-analysis of 22 studies and 1,280 patients found the same ordering: oral first, then injection, then topical.

Two things follow.

First, the most-evidenced melasma treatment is a tablet plus a cream, which no clinic profits from selling you a course of. That does not make it right for you — it is a prescription medicine with contraindications, and the reviews stress screening and cautious patient selection. It makes it the thing to ask about.

Second, if a clinic proposes an expensive device course and never mentions systemic or topical treatment, the plan is incomplete regardless of the device.

Where lasers do and do not fit

For melasma, the pooled evidence is specific and counterintuitive. Across 52 randomised trials and 1,058 participants:

Low-fluence Q-switched Nd:YAG — the classic "laser toning" — significantly beat controls (MD 1.47; 95% CI 0.08–2.85).
Picosecond lasers — newer and more expensive — did not (MD −0.11; 95% CI −0.79 to 0.57).
The overall pooled analysis was a non-significant trend.

The reviewers describe lasers here as adjunctive tools, and say directly that they should not be considered a panacea.

For sun spots, pigment-targeting lasers are on much firmer ground — a discrete lesion with a defined target is the case these devices were built for. The melasma finding is not an argument against lasers in general. It is an argument against buying one for melasma on the assumption that newer is better.

And laser carries a specific risk in this category: the same review reports post-inflammatory hyper- and hypopigmentation, particularly at high fluences. In pigmented skin, the treatment can create the problem.

Peels, and what they tell you about force

Peels work as single agents for melasma in darker skin. In a meta-analysis of 478 patients, glycolic acid outperformed trichloroacetic acid (MD −1.89; 95% CI −3.26 to −0.52).

Notice the pattern across this page. Twice, the gentler and cheaper option won: toning over picosecond, glycolic acid over trichloroacetic acid. Melasma responds poorly to force, and aggressive treatment in pigmented skin risks making it worse.

The part that decides your result

Every source here converges on the same unglamorous point.

The peel meta-analysis concludes peels are effective "with the use of topicals as maintenance treatment". A sequential peel protocol saw 70% recurrence within twelve weeks of stopping. The tranexamic acid literature reports recurrence once treatment ends.

And the only intervention in this whole field with a long randomised trial behind it is the free one: in a 4.5-year trial of 903 adults, the daily sunscreen group showed no detectable increase in skin aging, with 24% less aging than the discretionary-use group.

If you are flying in for a course of treatment, the course is the beginning. What you do for the following year is the treatment.

What to ask at a consultation

Which type of pigmentation do I have? Make this the first answer you get.
If melasma — what is the topical and systemic plan, not just the device plan?
Which device, at what fluence, and why that for my skin type?
What is the plan if I darken after a session, and can it be handled before I fly home?
What maintenance am I on afterwards, and can I get it at home?
What is the total cost of the course, not the session?

The bottom line

Pigmentation is at least four conditions and treating the wrong one is the standard expensive mistake. For melasma, the best pooled evidence is for oral tranexamic acid with topical treatment rather than any device — discussed with a doctor who screens you, since it is a prescription medicine. Among lasers, low-fluence Q-switched Nd:YAG beat controls across 52 trials and picosecond lasers did not. Glycolic acid beat trichloroacetic acid among peels. Everything recurs without maintenance and daily sun protection, which is the one intervention here with a 4.5-year randomised trial behind it.

Frequently asked questions

How do I know which kind I have?: You mostly cannot from a photograph, and that is why the first consultation question matters more than the device on offer. Melasma is patterned, symmetrical facial pigment driven by sun and hormones. Post-inflammatory marks follow a spot or a procedure and fade on their own. Sun spots are discrete and sun-exposed. Dermal pigment sits deeper and responds differently again. Ask your clinic to name yours before anything is switched on.
Does laser work for melasma?: One kind does. Across 52 randomised trials, low-fluence Q-switched Nd:YAG significantly beat controls (MD 1.47; 95% CI 0.08–2.85) while picosecond lasers did not (MD −0.11; 95% CI −0.79 to 0.57). The overall pooled analysis was a non-significant trend. Lasers in this field are described by the reviewers as adjunctive tools, not a cure.
What is tranexamic acid?: A prescription medicine, originally an antifibrinolytic, now widely used for melasma. In a network meta-analysis, oral tranexamic acid combined with routine topical agents produced the largest reduction in melasma severity at weeks 4, 8 and 12 and at last follow-up — ahead of intradermal, topical and microneedled delivery. A separate meta-analysis of 22 studies and 1,280 patients found the same ranking.
Is oral tranexamic acid safe?: The published reviews describe it as generally well tolerated, with gastrointestinal upset, menstrual irregularity, headache and skin irritation as the reported effects, and no major thromboembolic events across the studies reviewed. They also stress proper screening for contraindications and cautious patient selection — which is the reason this is a conversation with a doctor who knows your history, not a purchase.
Why does it keep coming back?: Because melasma is chronic and driven by ultraviolet light and hormones, neither of which a laser changes. One peel protocol saw 70% recurrence within twelve weeks of stopping. The tranexamic acid literature reports recurrence after treatment ends. This is why the reviewers frame maintenance as part of the treatment rather than an optional extra.
Does sunscreen actually make a difference?: More than any single procedure, and it is the only intervention here with a long randomised trial behind it. In a 4.5-year randomised community trial of 903 adults in Queensland, the daily sunscreen group showed no detectable increase in skin aging, with 24% less aging than the discretionary-use group.

Medical evidence

Systematic review2024
Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta-analysis
"Among various ways of administration of TA, oTA + RTA has the best effect on melasma. In the short term, the curative effect of oTA is better than that of iTA, and the onset time of oTA is faster than that of tTA, iTA and MNsTA."
Systematic review2026n = 1058
Efficacy and Safety of Laser-Based Therapies for Melasma: A Systematic Review and Meta-Analysis
Low-fluence Q-switched Nd:YAG significantly outperformed controls (MD 1.47; 95% CI 0.08–2.85); picosecond lasers did not (MD −0.11; 95% CI −0.79 to 0.57). "Laser-based therapies… should not be considered a panacea."
Randomised trial2013n = 903
Sunscreen and prevention of skin aging: a randomized trial
"Regular sunscreen use retards skin aging in healthy, middle-aged men and women." The daily sunscreen group showed no detectable increase in skin aging after 4.5 years; aging was 24% less than the discretionary group (relative odds 0.76; 95% CI 0.59–0.98).

Sources

Listed in the order they are used. Source class follows the methodology.

1.Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta-analysis, Journal of Cosmetic Dermatology, 2024Peer-reviewed researchaccessed 2026-09-08Network meta-analysis comparing routes of tranexamic acid. Oral tranexamic acid combined with routine topical agents gave a greater reduction in melasma severity than intradermal, topical or microneedled delivery at weeks 4, 8 and 12 and at last follow-up. Oral acted faster than every other route; over the long run, tranexamic acid alone performed similarly regardless of route.
2.Tranexamic acid as a therapeutic option for melasma management: meta-analysis and systematic review of randomized controlled trials, Journal of Dermatological Treatment, 2024Peer-reviewed researchaccessed 2026-09-0822 studies, 1,280 patients, treatment durations from 8 weeks to nearly 2 years. Tranexamic acid significantly reduced melasma severity across MASI, mMASI, melanin index and hemi-MASI. Oral administration produced the largest reduction, then injection, then topical. High heterogeneity between studies, particularly for combined treatments. Adverse effects: gastrointestinal discomfort, skin irritation, menstrual irregularities.
3.Tranexamic Acid for Hyperpigmentation Disorders: A Literature Review on Efficacy and Safety in Melasma and PIH, Journal of Cosmetic Dermatology, 2026Peer-reviewed researchaccessed 2026-09-08Reports MASI reductions of 49–95% with oral tranexamic acid at 250–500 mg twice daily in melasma. Evidence for post-inflammatory hyperpigmentation is weaker and mixed, with conflicting results for preventing laser-induced pigmentation across populations. Describes oral use as generally well tolerated with no major thromboembolic events reported in the studies reviewed, while stressing screening for contraindications and cautious patient selection.
4.Efficacy and Safety of Laser-Based Therapies for Melasma: A Systematic Review and Meta-Analysis, Cureus, 2026Peer-reviewed researchaccessed 2026-09-0852 randomised controlled trials, 1,058 participants. Low-fluence Q-switched Nd:YAG 1064 nm significantly effective (MD 1.47; 95% CI 0.08–2.85); picosecond lasers not significantly better than controls; overall pooled analysis a non-significant trend (MD 0.70; p = 0.2682). Post-inflammatory hyper- and hypopigmentation reported particularly with high fluences.
5.Efficacy and tolerability of chemical peeling as a single agent for melasma in dark-skinned patients: A systematic review and meta-analysis of comparative trials, Journal of Cosmetic Dermatology, 2020Peer-reviewed researchaccessed 2026-09-08478 patients across ten randomised trials and three prospective studies. Glycolic acid favoured over trichloroacetic acid on MASI (MD −1.89; 95% CI −3.26 to −0.52). Conclusion notes peels are effective "with the use of topicals as maintenance treatment".
6.Sunscreen and prevention of skin aging: a randomized trial, Annals of Internal Medicine, 2013Peer-reviewed researchaccessed 2026-09-08903 adults under 55, Nambour, Queensland, randomised to daily or discretionary sunscreen use and to β-carotene or placebo, assessed by blinded graders over 4.5 years. Daily sunscreen group showed no detectable increase in skin aging; aging 24% less than discretionary use (relative odds 0.76; 95% CI 0.59–0.98). β-carotene had no overall effect.

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