Deep vs Superficial Melasma: What's the Difference? Treating Dermal Melasma with a Dermatologist
Melasma is a common pigmentation disorder in Asian women and is often resistant to treatment. A key reason many people never get rid of their melasma is that they have not first worked out whether it is superficial or deep melasma. The two types have pigment at different depths and respond differently to treatment. This article explains the differences and the approach to treating deep melasma step by step.
How Deep and Superficial Melasma Differ
Based on the skin layer where melanin pigment accumulates, melasma is divided into 3 main types:
Superficial (Epidermal): The pigment sits in the epidermis. It is usually brown with fairly well-defined edges, responds to topical medication and is easier to treat.
Deep (Dermal): The pigment sits down in the dermis. It is usually grey-purple or blue-grey with poorly defined edges, is harder to treat, and often needs lasers such as Pico Laser or Q-switched Nd:YAG as well.
Mixed: Pigment is present in both the superficial and deep layers. It is the most common type in practice.
Accurately telling the types apart requires examination with tools such as a Wood's lamp and assessment by a dermatologist, because choosing a treatment that does not suit the type is the main reason melasma does not improve.
Why Deep Melasma Is Harder to Treat
Because the pigment in deep melasma lies in the deeper dermis, topical medication alone has difficulty reaching it. Treating deep melasma therefore needs several approaches used together (combination therapy) and takes longer. The aim is to lighten the pigment gradually while controlling trigger factors, not to expect a complete cure in a single session.
Approaches to Treating Deep Melasma
The following are options that dermatologists consider using in combination, depending on each person. Do not buy strong medications and use them on your own without consulting a doctor:
Oral medication: Oral Tranexamic acid, 250 mg 2-3 times a day for 6-12 months, is a standard approach that works well for deep melasma (it must be under a doctor's supervision, with contraindications checked before use).
Pico Laser: Pico Laser (Picosecond) helps break up pigment in the dermis. It generally takes 6-10 sessions, about 3-4 weeks apart.
Laser Toning: Q-switched Nd:YAG 1064 nm in a toning mode uses low energy and is done as a continuous course to lighten pigment gradually.
Topical medication: Hydroquinone 4% together with Tretinoin 0.025% and a corticosteroid (Kligman's Triple Combination formula), as well as Cysteamine and Azelaic acid, are topical options.
Chemical Peel: Jessner's solution, TCA 10-15% or Glycolic acid 30-70% helps exfoliate the skin to support the main treatment.
Microneedling: Microneedling with Tranexamic acid serum is another supporting approach in some cases.
Sun protection (never skip it): Broad spectrum sunscreen SPF 50+ PA++++ applied every day and reapplied is the heart of treatment for every type of melasma. Without sun protection, melasma will always come back.
Taking Care of Yourself During Treatment
Protect against sunlight: Apply sunscreen every day and reapply during the day. Wear a hat, use an umbrella and avoid strong sun.
Do not harm your skin: Avoid scrubbing or using irritating products, because inflammation can make melasma darker.
Be patient and consistent: Keep up the treatment as your doctor schedules it, because deep melasma needs time and consistency.
Frequently Asked Questions
How do superficial and deep melasma differ? Superficial melasma has pigment in the epidermis, is brown with clear edges and is easier to treat. Deep melasma has pigment in the dermis, is grey-purple with poorly defined edges, is harder to treat and often needs lasers such as Pico Laser or Q-switched Nd:YAG as well.
Can deep melasma be cured completely? Deep melasma usually does not go away permanently, but it can be lightened considerably and kept from darkening again through continuous treatment, controlling trigger factors and strict sun protection.
How strict does sun protection need to be? Very. Sunlight is the most important trigger of melasma. Broad spectrum sunscreen SPF 50+ PA++++ is recommended every day and should be reapplied, even indoors or on days without strong sun.
Does treating deep melasma take a long time? It generally takes several months to a year, because the pigment lies deep and a combination of treatments is needed. Consistency and follow-up with your doctor are the key.
If you have been treating melasma for a long time without improvement, or are unsure which type you have, we recommend an assessment by a dermatologist. At Siam Dermatology we diagnose the type of melasma with a Wood's lamp and plan treatment for each individual. Consult a dermatologist at Siam Dermatology by phone at +66 61 448 7000 or LINE @siamderm
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026
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