A cream, lotion, gel or liquid containing hydroquinone is often the first treatment for melasma, according to the American Academy of Dermatology. Applied to the affected area, it works by lightening the skin. It is available without a prescription, but these products contain less hydroquinone than a dermatologist can prescribe.
A second course of treatment may involve a prescription for tretinoin or corticosteroid, or a cream containing both these ingredients, as well as hydroquinone, often called a triple cream. Other topical medicines include azelaic acid and kojic acid, says the American Academy of Dermatology. If topical medicine is not effective at clearing up melasma, a dermatologist may perform a procedure, such as a chemical peel, microdermabrasion or dermabrasion.