Deep vs Superficial Melasma: What's the Difference? Treating Dermal Melasma with a Dermatologist
Melasma is a common pigmentation condition in Asian women, and it 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 to treatment differently. This article explains the differences and the approach to treating deep melasma.
How do deep and superficial melasma differ?
Melasma is divided into 3 main types according to the skin layer where melanin pigment accumulates:
Superficial melasma (Epidermal): The pigment sits in the epidermis. It is usually brown with fairly clear borders, responds to topical medications and is easier to treat.
Deep melasma (Dermal): The pigment lies in the dermis. It is usually grey-purple or blue-grey with indistinct borders, is harder to treat, and often needs lasers such as Pico Laser or Q-switched Nd:YAG as well.
Mixed melasma: Pigment is present in both the superficial and deep layers. In practice, this is the most common type.
Accurately identifying the type of melasma requires examination with tools such as a Wood's lamp and an assessment by a dermatologist, because choosing a treatment that does not suit the type is the main reason melasma does not improve.
Why is deep melasma harder to treat?
Because the pigment in deep melasma lies in the deeper dermis, topical medications alone have difficulty reaching it. Treating deep melasma therefore needs several approaches used together (combination therapy) and takes longer. The goal is to lighten the pigment gradually while controlling the triggers, not to expect a complete cure in a single step.
Treatment options for deep melasma
The following are options that dermatologists consider using in combination, depending on each person's suitability. 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 taken under a doctor's care, with contraindications checked before use).
Pico Laser: Pico Laser (Picosecond) helps break up pigment in the dermis. Generally 6-10 sessions are needed, about 3-4 weeks apart.
Laser Toning: Q-switched Nd:YAG 1064 nm in a toning mode uses low energy and is given as a continuous course to lighten pigment gradually.
Topical medications: Hydroquinone 4% with Tretinoin 0.025% and a corticosteroid (the 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% help exfoliate the skin as a supplement to the main treatment.
Microneedling: Microneedling with Tranexamic acid serum is another supplementary approach in some cases.
Sun protection (never skip it): Broad-spectrum sunscreen SPF 50+ PA++++, applied every day and reapplied, is the cornerstone of treating every type of melasma. Without sun protection, melasma will always come back.
Self-care during treatment
Protect from 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 borders and is easier to treat. Deep melasma has pigment in the dermis, is grey-purple with indistinct borders, 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, control of triggers and strict sun protection.
How strict do I need to be about sun protection? Very strict. Sunlight is the most important trigger of melasma. We recommend broad-spectrum sunscreen SPF 50+ PA++++ applied every day and reapplied, even when you are 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 needs combined treatment. Consistency and follow-up with your doctor are key.
If you have been treating melasma for a long time without improvement, or you are not sure 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: call +66 61 448 7000 or LINE @siamderm
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026
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