Where to Treat Melasma in Bangkok and Samut Prakan: A Dermatologist Explains How to Choose a Clinic, How Epidermal, Dermal and Mixed Melasma Are Treated Differently, and the Medicines Actually Used

3 days ago

17 min read

Where to treat melasma around Bangkok and Samut Prakan: the short answer

If your melasma is complicated or you have other conditions, start with a hospital dermatology department. If you want to be seen close to home on the Samut Prakan or Bangna side and return for follow-up every 4–8 weeks, choose a clinic where a specialist dermatologist does the examination.

Siam Dermatology is the specialty dermatology clinic of this article's author, at 536/1 Moo 3, Theparak Road, Theparak, Mueang Samut Prakan, Samut Prakan 10270. The clinic has one location and no branch in Bangna. It is about 9.5 km from Central Bangna and about 750 m from Thipphawan Station on the Yellow Line. The doctors who examine melasma are dermatology teaching physicians: Dr. Patara Voravutinon (Medical Council license 54323), Dr. Nataya Voravutinon, Dr. Supawee Phanmamuang, Dr. Wasin Saowaluksakul, Dr. Nuttapatsorn Wiwatsombat and Dr. Thanyasak Bespiyowong. Each doctor's days differ, so please ask for the schedule before booking. The doctor examines your face in person to identify the melasma type first. The plan starts with tinted sunscreen and topical medicine, and low-energy picosecond laser is an add-on when the doctor judges it necessary. The dermatology outpatient service is open Monday, Tuesday, Thursday and Friday 16:30–20:00, closed Wednesday, and Saturday–Sunday 08:30–16:00. Call +66 61 448 7000 or LINE @siamderm.

Melasma is a chronic condition that can be lightened and controlled, but it can darken again. Procedures carry risks, and results vary from person to person.

Ask “where is the best place to treat melasma?” and you usually get a list of clinics and laser machine names, which answers the question in the wrong order. What decides whether melasma gets better or worse is not the location but three things that happen at the first doctor’s visit: whether the melasma is classified correctly, whether the plan starts with evidence-based medicines or with the procedure that is easiest to sell, and whether anyone is honest with you that melasma is a chronic condition that needs ongoing care.

This article is written from a dermatologist’s point of view so that you can assess any clinic in Bangkok or Samut Prakan yourself. It explains how each type of melasma differs, which medicines are actually used (with strengths and durations), which procedures help and which can make things worse, the warning signs that should make you walk away, and the questions to ask before you pay.

A short summary for those in a hurry

Effective melasma treatment starts with classifying the type as epidermal, dermal or mixed, by examining your face in person, not by judging from a photo in a chat.
The first-line treatment with the best evidence is sunscreen that also blocks visible light, plus a doctor-prescribed combination cream, not a laser.
Lasers and procedures are an add-on for melasma that does not respond to medicines, and some lasers can darken melasma if the wrong type or energy is used.
Melasma is chronic and tends to come back. A clinic that guarantees a permanent cure is saying something that does not match medical knowledge.
Choose a place with a board-certified dermatologist whose credentials can be verified, who examines your face in person, explains a stepwise plan, and is easy enough to reach for follow-up every 4–8 weeks.

Why “where is best” has to start with “which type of melasma”

Melasma is a condition in which pigment-producing cells on the cheekbones, forehead, nose and upper lip become overactive because of combined triggers: sunlight, hormones, genetics and heat. The result is brown to grey-brown patches with indistinct borders, appearing on both sides symmetrically and becoming clearly darker after sun exposure.

What makes treatment differ so much is how deep the pigment sits. Most topical medicines act in the epidermis, while pigment that has dropped into the dermis is taken up by cells and responds to treatment far more slowly. A clinic that does not classify the type first therefore gets results that look like guesswork: some people improve quickly, some do not move, and some get worse, with no one able to explain why.

Epidermal melasma

The pigment sits in the epidermis; the colour is dark brown and the borders are fairly distinct.
Under long-wave ultraviolet light (Wood’s lamp), the patch becomes clearly darker compared with the surrounding skin.
It responds best to topical medicines, and changes are usually visible within 8–12 weeks.

Dermal melasma

The pigment sits in the dermis; the colour is grey-brown or blue-grey and the borders are indistinct.
Under ultraviolet light, the colour does not become darker, because the light is absorbed before it reaches the pigment.
It responds slowly and incompletely to topical medicines, and needs a long-term plan combining several treatments.

Mixed melasma

This is the most common type in Thai patients, with both layers present in the same patch: some areas darken under the light and some do not.
The superficial part fades first while the deep part remains, which is why this group often feels that treatment “only worked halfway”.

Besides these three types, the doctor also has to decide whether the patch is really melasma, because conditions often wrongly treated as melasma include acquired nevus of Ota-like macules (grey-blue separate dots on the cheekbones, not a patch), post-inflammatory hyperpigmentation from acne or from an earlier laser, pigmentation caused by certain drugs, and permanent darkening of the skin from using hydroquinone continuously for too long (exogenous ochronosis), which gets darker if it is treated with more melasma medicine. For details on telling melasma apart from freckles and dark marks, we already have a dedicated article: What causes melasma, and how to tell it apart from freckles, nevus of Ota-like macules and dark marks

The examination that should happen at the first visit

The fastest way to tell clinics apart is to see whether your first visit involved a real examination or only a sales pitch. A systematic melasma assessment should include the following.

A history focused on triggers: birth control pills or hormone replacement, pregnancy, regular medicines (for example some anti-seizure drugs), sun exposure at work or while travelling, family history, and every product you have applied to your face in the past year, including creams with no label.
An in-person examination in adequate light, with long-wave ultraviolet light to assess depth. Some doctors also use a skin microscope (dermoscopy) to tell melasma from nevus of Ota-like macules and to check for dilated capillaries.
A numerical severity score such as mMASI (scoring area and darkness), or at least standardised photos under the same light and angle, so that next month there is something real to compare against, not just a feeling.
An explanation of your melasma type and a stepwise plan: what to start with, when it will be reassessed, and what changes if there is no response.

If the first visit ends with an offer of a course of several laser sessions and items 2 and 4 are missing, that is enough information to make a decision.

Sunscreen: the foundation every treatment stands on

Every melasma treatment can fail for the same reason, which is insufficient sun protection. “Insufficient” in the medical sense does not mean forgetting to apply it; it means applying the wrong type or the wrong amount.

It must be broad-spectrum, covering both UVA and UVB, with SPF 50 or higher and PA++++.
It must also block visible light, because the blue light in sunshine can directly stimulate pigment in darker skin. Ordinary clear sunscreens do not cover this; you need a tinted formula that uses iron oxide pigments as the filter. In comparative studies, the group using tinted sunscreen together with medicine had significantly more lightening than the group using clear sunscreen.
The amount for the face and neck is about two finger lengths. Apply it 15 minutes before leaving home and reapply every 2 hours outdoors or after heavy sweating.
Apply it even indoors if you sit by a window or drive, because UVA passes through glass.
A wide-brimmed hat and avoiding the sun between 10:00 and 16:00 are part of the treatment, not optional extra advice.

If a clinic never mentions this, or mentions it in passing without saying that it must be tinted, that tells you something about the depth of care.

Topical medicines actually used: generic names, strengths and durations

The following are the evidence-based medicines dermatologists actually use for melasma. They are listed so that you understand what the doctor is giving you and can ask questions if you receive a cream that does not name its active ingredients. The choice of medicine, strength and duration for each person is a decision for the doctor who examines you.

Hydroquinone 2–4%

The skin-lightening medicine with the longest track record; it directly inhibits the enzyme that produces melanin.
In Thailand it is classed as a medicine that must be obtained from a doctor or pharmacist and may not be put in cosmetics. Any over-the-counter melasma cream that contains hydroquinone is therefore an illegal cosmetic.
It is applied thinly to the melasma areas once a day at bedtime, with clear results at 8–12 weeks. Use it continuously for no more than 3–4 months, then take a break or switch to a maintenance medicine, because continuous high-concentration use for many years is associated with permanent darkening of the skin (ochronosis).
Signs of incorrect use: marked stinging, redness and peeling, or lightening of the skin around the melasma in a ring with a visible edge (halo). Stop and return to the doctor.

Triple combination cream

Hydroquinone 4% + tretinoin 0.05% + fluocinolone acetonide 0.01% in a single formulation.
This is the first-line treatment recommended by clinical guidelines for moderate to severe epidermal and mixed melasma, because the three ingredients complement each other: one reduces pigment production, one speeds the shedding of pigment, and the mild steroid reduces the irritation that makes melasma darker.
It is applied thinly to the melasma areas once a day at bedtime for 8 weeks, after which the doctor reassesses and reduces the frequency to maintenance. It is not used continuously beyond the set period because it contains a steroid.
Early side effects: redness, peeling and mild stinging in the first 2 weeks are considered normal. If they go beyond that or are severe, the treatment needs adjusting.

Tretinoin 0.025–0.05% alone

Used in people who are not suited to hydroquinone. It acts more slowly and must be used continuously for 24 weeks or more before clear results appear.
It must not be used by people who are pregnant or planning a pregnancy.

Azelaic acid 15–20%

Applied twice a day for 12–24 weeks; in several studies its effectiveness is close to hydroquinone 2%.
It is an option that can be used during pregnancy and breastfeeding and suits people who also have acne.
The side effect is temporary stinging and itching at the start.

Cysteamine 5%

Applied as a short-contact treatment: put it on for 15 minutes and then wash it off, once a day for 16 weeks.
It is an alternative for people who do not want or should not use hydroquinone. Its limitations are the smell and stinging in the early period.

Other supporting medicines used together

Kojic acid 1–4% and niacinamide 4–5% help when used together with the main medicine, but their effect alone is limited.
Topical tranexamic acid 2–5% has a moderate effect with little irritation and can be used in the maintenance phase.

We compare the three main medicines in detail, with the pros and cons of each, in the article Hydroquinone vs tranexamic acid vs cysteamine: which melasma medicine suits whom.

Oral tranexamic acid: who can use it and who must not

Oral tranexamic acid was originally a medicine to stop bleeding, but it was found to reduce the stimulation of pigment cells by blood vessels and UV light. It is therefore used for melasma that does not respond to topical medicines, or for mixed and dermal melasma where topical treatment alone is not enough.

The dose used in most studies is 250 mg twice a day for 8–12 weeks. Results appear from week 4–8, and it should always be used together with topical medicine and sunscreen.
This is an off-label use (outside the registered indications), so the doctor must explain it and take a history every time.
It must not be used by people who have had blood clots, stroke or heart disease, people who are taking combined hormonal contraceptives, people who are pregnant, heavy smokers, people with kidney disease or clotting problems, and people who must sit still for long periods, such as frequent long-distance travellers.
Symptoms that mean you must stop the medicine and see a doctor immediately: pain and swelling in one calf, chest pain, difficulty breathing, or sudden blurred vision.
After stopping, melasma can return within 2–3 months if there is no topical medicine and sunscreen to support it. This medicine is therefore an accelerator, not a finishing treatment.

A clinic that prescribes oral melasma medicine without asking at all about birth control pills and a history of blood clots is a clinic to be cautious about.

Procedures and lasers: add-ons that must be used in the right place

The correct order is medicines and sunscreen first, then consider a procedure if 8–12 weeks have passed and it is still not enough, or when it is mixed or dermal melasma where you know in advance that topical medicine will not reach. Every procedure must be done together with topical medicine and sunscreen, otherwise the result will not last and there is a risk of more dark marks.

Chemical peel

Glycolic acid 30–70% or salicylic acid 20–30% is applied and then washed off, at intervals of 2–4 weeks, for 4–6 sessions.
It suits epidermal melasma and helps speed up the shedding of pigment in the upper layers of the skin, but if the concentration is too high or it is done too often on Thai skin, you get post-inflammatory dark marks instead.

Low-energy picosecond laser

It delivers very short picosecond pulses to break pigment into small particles with little accumulated heat, used in low-energy mode over multiple sessions, 2–4 weeks apart.
It is an add-on for mixed and dermal melasma that does not respond to medicines, not a first-line treatment, and it must be done together with topical medicine.
Risks to know before agreeing: melasma returning darker than before (rebound) if topical medicine is stopped after the procedure, and patchy white spots (guttate hypopigmentation) if it is done too often or with too much energy, which is harder to treat than the original melasma.

Radiofrequency microneedling (RF microneedling)

It delivers radiofrequency energy into the dermis through fine needles; there is data suggesting that it reduces the capillaries that feed melasma and helps carry medicines such as tranexamic acid into deeper skin.
It is used for melasma with a vascular component, or dermal melasma that does not respond to other methods. It is an option that must be assessed for each individual.

Lasers to be careful with

Lasers that deliver a lot of heat, or aggressive resurfacing lasers, trigger inflammation and often make melasma darker in Asian skin.
Being offered a “one session and it’s gone” laser, or a package of dozens of sessions with no topical medicine plan, is a sign that the seller is not treating melasma.

Melasma that is not improving: change clinics, or change the question

Before concluding that the clinic is no good, check these 5 points first, because they are more common causes than wrong treatment.

The sunscreen is not tinted, or not applied in the full amount. This is the number one reason melasma does not budge.
The medicine has not been used long enough. Most topical medicines need 8–12 weeks and oral medicine 8 weeks. Judging at 3–4 weeks is too early.
The triggers are still there, for example still using combined hormonal birth control, working outdoors, or repeatedly using irritating products.
The melasma is deep or mixed, which naturally responds slowly and not completely. Expectations need to be adjusted to “lighter and under control”, not “gone”.
What is being treated may not be melasma, for example nevus of Ota-like macules that need a different kind of laser, or darkening from accumulated hydroquinone that requires stopping the medicine immediately.

If you have checked all of these and there is still no improvement after 3–4 months under a plan carried out in full, that is the time to get a second opinion from a specialist dermatologist. We explain the approach for resistant melasma in Melasma not going away: what to do next, and go into how deep and superficial melasma differ in treatment.

Warning signs of a clinic to walk away from

Guaranteed results, such as a permanent cure or clearance within a set number of sessions. Melasma is a chronic condition, and current medical knowledge does not support a guarantee like this.
A cream with no label, no active ingredient names, or only the clinic’s name. You have the right to know what you are putting on your face. Melasma creams that work unusually fast, within 1–2 weeks, often contain a high-potency steroid or mercury, which thins the skin, dilates capillaries and causes acne, and when stopped the melasma comes back darker than before.
Assessment and planning through chat or photos without ever examining your face in person.
A plan that has only procedures, with no part for topical medicine and sunscreen, or a large package offered at the very first visit before it is clear what you respond to.
No questions about birth control pills, pregnancy or blood clots before prescribing oral medicine.
Unable to say who the treating doctor is and what board certification they hold.

How to verify that a doctor is a genuine dermatologist

In everyday speech, “skin doctor” covers everything from specialists who have completed 3–4 years of dermatology training and passed board examinations to general practitioners with an interest in aesthetics. Both are legally registered doctors, but they differ in the depth of their skin-disease differential diagnosis, and for melasma, differential diagnosis matters.

Ask for the treating doctor’s full name and check it in the search system of the Medical Council of Thailand, which lists the board certificate or certification in each field. The field you want is Dermatology.
The clinic should display a healthcare facility licence and an operating licence where they can be seen, along with name tags for the doctors who actually work there on the day.
Ask directly, “Who is examining me today?” The answer should be a doctor’s name, not a staff job title.
The words “expert”, “specialist” or an institution’s name on a sign are not evidence in themselves. The evidence is a register that can be checked.

Bangkok or Samut Prakan: distance affects results more than you think

Melasma treatment is not a one-time visit. The standard plan is reassessment every 4–8 weeks for at least 3–6 months, followed by long-term maintenance. Distance is therefore a medical factor, not just a convenience, because patients who have to travel far often postpone appointments, and postponing during the period when medicines need their strength adjusted is exactly where melasma tends to come back.

Large hospitals in Bangkok suit complicated melasma, coexisting conditions, or medicines that require blood-test monitoring. The limitations are long waits and often seeing a different doctor each time.
A dermatology specialty clinic near home in Samut Prakan or the Bangna area gives continuity with the same doctor who sees your face every month, which is what melasma needs. The condition is that it must be a verifiable specialist dermatologist, not a general aesthetic clinic.
People living around Thepharak, Samrong, Bearing, Bangna, Bang Phli or Pak Nam do not need to go into the city to see a dermatology teaching physician, which makes monthly follow-up realistic. Siam Dermatology has one location on Theparak Road and is one option in this area.

The point is to choose the place you will be able to attend for every appointment over the next 6 months, not the best-known place that you will only visit once.

Questions to ask before agreeing to treatment

Take this set of questions to your first visit. The answers will tell you more about the quality of a clinic than reviews will.

What type is my melasma, epidermal, dermal or mixed, and what is that based on?
What is the first step of the plan, which medicine, what strength, for how long, and when will it be reassessed?
What sunscreen should I use, and why?
If there is no improvement after 12 weeks, what is the next step?
What role does the proposed procedure play in the plan, and what risks does it carry for my skin specifically?
After it has lightened, how do I keep looking after it so it does not come back?
Who is the treating doctor, and what board certification do they hold?

A good dermatologist will be glad you asked these questions, because they are the same questions the doctor is already asking themselves.

Melasma in special situations that call for a different approach

Melasma during pregnancy and breastfeeding

Very common in the second and third trimesters; some fades on its own within 6–12 months after delivery.
In the meantime, only tinted sunscreen, azelaic acid and vitamin C can be used. Hydroquinone, tretinoin and oral tranexamic acid must not be used.
If it is still there one year after delivery, the standard plan can then begin.

Melasma that started after beginning birth control pills

Talk to an obstetrician-gynaecologist about switching to a contraceptive method without estrogen. Treating melasma while the trigger is still present will not give full results.

Melasma in men

Seen in about 10% of melasma patients, usually linked to sun and genetics more than hormones. The treatment approach is the same, but it is often diagnosed late because it is rarely thought of.

Melasma together with sensitive skin or skin thinned by steroids

The skin barrier must be restored first, for 4–8 weeks, with moisturisers and by stopping all irritating products, and only then are low-strength melasma medicines started. Rushing to use strong medicine on skin that is still inflamed leads to more dark marks.

Realistic expectations

Epidermal melasma under the standard plan usually fades by 50–70% within 3 months.
Mixed and dermal melasma fade more slowly and usually not completely. The goal is a more even colour that no longer worries you, and keeping it from coming back.
The chance of recurrence is high, especially in the hot season and after stopping medicine without a maintenance plan. People who manage melasma well in the long term are those who accept this from the start and make tinted sunscreen a habit.
No method makes melasma go away permanently without ongoing care. Anyone who says otherwise is selling something.

Frequently asked questions about where to treat melasma

Where is best to treat melasma, a hospital or a clinic?

Either works if a specialist dermatologist actually examines you and plans your treatment. What should decide it is not the type of place but four points: your face is examined in person and the melasma type is identified before treatment; the plan starts with tinted sunscreen and topical medicines whose active ingredients are named; there is no guarantee of a permanent cure; and you can attend follow-up every 4–8 weeks for 6 months. A large hospital suits complicated melasma or coexisting conditions, while a specialty clinic near home gives continuity with the same doctor, which melasma needs a great deal.

Can melasma go away for good?

In current medical knowledge, melasma is a chronic condition that can return, so it is not considered possible to cure it permanently. But it can be lightened until the skin tone is even and kept from returning with tinted sunscreen and maintenance medicine. Epidermal melasma usually responds well and may become barely visible, while dermal and mixed melasma usually lighten but not completely. Understanding this from the start matters, because people who expect one round of treatment to finish it often stop sunscreen and maintenance medicine too early, and the melasma returns the next hot season.

How long does melasma treatment take to show results?

First-line topical medicines such as the triple combination or hydroquinone 4% show clear change at 8–12 weeks. Oral tranexamic acid starts to show at 4–8 weeks. Azelaic acid and cysteamine need 12–16 weeks, and dermal melasma may need 6 months or more with several methods combined. Assessing at 3–4 weeks and concluding that it did not work is too early. It is better to compare standardised photos every month than to judge by feeling.

Is laser good for melasma, and does it clear it straight away?

Laser is an add-on for melasma that resists topical medicine or is deep, not a first-line treatment, and no laser clears melasma permanently in one session. Low-energy picosecond laser over multiple sessions together with topical medicine can help resistant melasma fade faster, but there is a risk of melasma returning darker than before if topical medicine is stopped after treatment, and a risk of patchy white spots if it is done too often or with too much energy. High-heat lasers often make melasma darker in Asian skin. If a laser is offered at the very first visit before there is a plan for topical medicine and sunscreen, you should ask for a second opinion.

What melasma medicines do doctors prescribe?

The main topical medicines dermatologists use are hydroquinone 2–4% or the triple combination containing hydroquinone 4%, tretinoin 0.05% and fluocinolone 0.01%, applied at bedtime once a day for 8–12 weeks. Other options are azelaic acid 15–20%, cysteamine 5% and topical tranexamic acid. The oral medicine is tranexamic acid 250 mg twice a day for 8–12 weeks for resistant melasma, which requires a history of blood clots and birth control use first. Every one must be used with tinted sunscreen of SPF 50 or higher, and the choice of medicine, strength and duration is the decision of the doctor after examining your face in person. A melasma cream whose label does not name its active ingredients should not be used.

Can melasma creams sold over the counter be used?

Products registered as cosmetics in Thailand may not contain hydroquinone, steroids or mercury. A legal over-the-counter melasma cream can therefore contain only mild ingredients such as niacinamide, vitamin C, kojic acid or arbutin, which help only to a limited extent and suit maintenance more than treatment. A melasma cream that works unusually fast, within 1–2 weeks, often contains a banned substance, which thins the skin, dilates capillaries and makes melasma come back darker than before once stopped. Before buying, check the notification number against the database of the Food and Drug Administration, and if the melasma is noticeable enough to bother you, seeing a dermatologist for the right medicine is better value than trial and error.

References

Ogbechie-Godec OA, Elbuluk N. Melasma: an up-to-date comprehensive review. Dermatology and Therapy.
McKesey J, Tovar-Garza A, Pandya AG. Melasma treatment: an evidence-based review. American Journal of Clinical Dermatology.
Taylor SC, Torok H, Jones T, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis.
Castanedo-Cazares JP, Hernandez-Blanco D, Carlos-Ortega B, et al. Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial. Photodermatology, Photoimmunology and Photomedicine.
Del Rosario E, Florez-Pollack S, Zapata L, et al. Randomized, placebo-controlled, double-blind study of oral tranexamic acid in the treatment of moderate-to-severe melasma. Journal of the American Academy of Dermatology.
Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma. British Journal of Dermatology.
Trivedi MK, Yang FC, Cho BK. A review of laser and light therapy in melasma. International Journal of Women's Dermatology.
Clinical guideline for the care of melasma, Dermatological Society of Thailand
Ministry of Public Health notification on substances prohibited as ingredients in cosmetics

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed September 21, 2026