Hydroquinone vs Tranexamic Acid vs Cysteamine: Which Melasma Treatment Is Better? Comparing the 3 Main Options

There are 3 main groups of topical melasma treatments in wide use today: Hydroquinone, Tranexamic acid and Cysteamine. Each works differently and has different effectiveness and side effects. This article compares all 3 based on medical evidence, written by Dr. Supawee Phanmamuang, a dermatologist with research experience, to help you understand which type of melasma each one suits. However, choosing a treatment should always be done under a doctor's care.

Hydroquinone 4%: the standard treatment

Hydroquinone has been the standard topical melasma treatment for more than 50 years. It works by inhibiting the enzyme tyrosinase, which reduces the production of melanin pigment.

• Effectiveness: Reduces melanin production by about 50-70% within 12-16 weeks.

• Combination formulas: The triple combination (Hydroquinone 4% + Tretinoin 0.05% + Fluocinolone), also known as the Kligman formula, gives better results.

• Side effects: It may cause irritation, and with long continuous use it may lead to cumulative skin darkening (ochronosis), which is uncommon.

• Precautions: It should not be used continuously for more than 4 months, and use should be cycled with breaks.

Tranexamic acid: topical and oral

Tranexamic acid works by inhibiting plasminogen, which helps reduce the substances that stimulate pigment-producing cells (melanocytes).

• Effectiveness: The 3% topical form reduces melasma by about 30-50% in 12 weeks, while the oral form, 250 mg twice daily, reduces melasma by about 50-60% in 3 months.

• Side effects: The oral form carries a risk of blood clots (thromboembolism), so a medical history must be taken and use must be under a doctor's care.

• Key advantage: It does not irritate the skin and can be used together with Hydroquinone.

Cysteamine 5%

Cysteamine is an antioxidant that inhibits tyrosinase and binds copper (copper chelation), which helps reduce pigment production.

• Effectiveness: Reduces melasma by about 70% in 16 weeks (comparable to Hydroquinone).

• Key advantage: It does not cause ochronosis and does not make the skin more sensitive to irritation.

• Limitations: It is more expensive and has a distinctive sulfur-like smell.

Which melasma treatment should you choose?

The choice depends not on the brand but on how deep the pigment is and what type of melasma you have. The general guidance is as follows.

• Superficial melasma: Mild to moderate superficial melasma is usually started on a Hydroquinone 4% combination formula for about 8-12 weeks.

• Deep or mixed melasma: For deep or mixed melasma, adding oral Tranexamic acid may be considered.

• During breaks from treatment: During breaks from Hydroquinone, Cysteamine 5% may be used for continued care.

Frequently asked questions

Which melasma treatment is the best? No single treatment is best for everyone. The choice depends on how deep the pigment is and what type of melasma you have. Hydroquinone suits superficial melasma, while Tranexamic acid and Cysteamine suit some cases. A doctor should assess you.

Can Hydroquinone be used long term? It should not be used continuously for more than 4 months, and use should be cycled with breaks, because prolonged continuous use may cause cumulative skin darkening.

Is oral Tranexamic acid safe? It carries a risk of blood clots, so a medical history must be taken and it must be used only under a doctor's care.

How is Cysteamine different from Hydroquinone? Cysteamine reduces melasma to a similar degree, but it does not cause ochronosis and does not make the skin more sensitive to irritation. Its limitations are a higher price and a distinctive smell.

To treat melasma effectively and safely, choose a treatment that suits the type of melasma and use it under a doctor's care. Consult a dermatologist at Siam Dermatology: phone +66 61 448 7000 or LINE @siamderm

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026