Melasma and Dark Spot Treatment at Siam Dermatology, Samut Prakan

6 days ago

13 min read

Updated: 4 days ago

Siam Dermatology, a dermatology specialist clinic, examines and treats melasma under the care of a dermatologist. It is located on Thepharak Road, Mueang Samut Prakan, about 9.5 kilometres from Central Bangna, or roughly 12–15 minutes by car in normal traffic. Melasma is a condition in which the skin produces too much melanin pigment, leaving brown to grey patches on both sides of the face. It is most common on the cheekbones, forehead, nose and above the upper lip. The main triggers are sunlight, hormones and genetics.

Melasma can be controlled and lightened, but it can darken again if the triggers are still present. This page answers the three questions people around Samut Prakan and Bangna ask most often: where the clinic is, who examines you, and how melasma treatment proceeds step by step. For general advice on choosing a clinic, read Where to Get Melasma Treated: Bangkok–Samut Prakan

Clinic at a glance

Name: Siam Dermatology, a dermatology specialist clinic (formerly Dr. Patara's Clinic)
Address: 536/1 Moo 3, Thepharak Road, Thepharak Subdistrict, Mueang Samut Prakan District, Samut Prakan 10270
Examining doctor: Dr. Patara Voravutinon, Dermatologist, medical licence no. 54323
Consultation hours: Monday, Tuesday, Thursday, Friday 16:00–20:00. The consultation clinic is closed on Wednesday.
Other opening hours: Laser and dermatologic surgery, Monday–Friday 16:00–20:00 · Saturday–Sunday 08:00–16:00
Rail: Thipphawan Station (MRT Yellow Line), about 750 metres
Contact: Tel. +66 61 448 7000 · LINE @siamderm

What we check before starting melasma treatment

The treatment plan changes with the type of melasma and its triggers, so the first visit is designed to answer these 4 questions before any drug or procedure is chosen.

Is it really melasma? Dark marks on the face have many causes, such as sun freckles, post-inflammatory dark marks and deep-layer birthmarks. Each responds differently to treatment.
How deep is the pigment? The standard assessment is to examine the face in adequate light, together with long-wave ultraviolet light or a skin magnifier when needed.
What is triggering it? We ask about birth control pills, hormone replacement, pregnancy, regular medicines, time spent outdoors and every cream you apply.
Is there any reason not to treat? For example, pregnancy or breastfeeding, a past blood clot, sensitive skin, or long-term use of steroid creams on the face.

Please bring the creams you use, including any bought online, because some ingredients can darken or thin the skin without you realising. To learn more about the condition itself, read Melasma: Causes and How to Tell It Apart from Other Marks

Epidermal melasma

Appearance: Brown patches with fairly sharp edges on the cheeks, forehead or above the upper lip.

Cause: Pigment collects in the epidermis, triggered by sun, hormones and irritation.

Severity/urgency: Not dangerous and not urgent. It usually responds to topical medicine together with tinted sunscreen, with changes starting to show within 8–12 weeks.

When to see a doctor: When it has not lightened after more than 8 weeks of treating it yourself, it is getting darker, or your skin is red and stinging from a cream.

Dermal melasma

Appearance: Grey-brown or bluish patches with indistinct edges.

Cause: Pigment has fallen into the dermis, where topical medicine reaches only to a limited extent.

Severity/urgency: Not dangerous, but it lightens slowly and needs continuous planning over months. High-energy lasers may make it darker.

When to see a doctor: Before starting any laser or procedure, because it must first be distinguished from deep-layer birthmarks. Read more in Dermal vs Epidermal Melasma: What Is the Difference?

Mixed melasma

Appearance: Some areas dark brown, some grey, on the same patch. This is the type commonly seen in Thai skin.

Cause: Pigment is present in both the epidermis and the dermis, often with accumulated sun damage and tiny blood vessels as well.

Severity/urgency: Not dangerous. The superficial part lightens first and the deeper part lightens slowly, so treatment may seem to stall in the later stage.

When to see a doctor: When a full 12 weeks of topical medicine has not improved it enough, or when melasma has darkened after laser. See the next steps in Melasma Not Fading: What to Do Next

Melasma during pregnancy and after starting birth control

Appearance: Melasma that has newly appeared or darkened quickly during pregnancy, or within a few months of starting hormonal medicine.

Cause: Oestrogen and progesterone stimulate the pigment-producing cells, together with sunlight.

Severity/urgency: Not dangerous. Some pregnancy-related melasma fades on its own within 6–12 months after delivery. During pregnancy, tinted sunscreen is the mainstay and the doctor may consider azelaic acid, while avoiding hydroquinone, tretinoin and oral tranexamic acid.

When to see a doctor: Before using any pigment-lightening medicine during pregnancy or breastfeeding. If you suspect the pill is the trigger, discuss contraception options with a gynaecologist. Do not stop the pill by yourself without a replacement method.

Solar lentigines (sun freckles)

Appearance: Brown spots with sharp edges, from a few millimetres to about 1–2 centimetres, separate spots rather than the symmetrical patches of melasma.

Cause: Years of accumulated sun exposure, most common from middle age onwards.

Severity/urgency: Not dangerous. They respond to laser very differently from melasma, so using the same settings across the whole face may darken melasma sitting next to them.

When to see a doctor: When a spot grows quickly, has uneven colour or a rough border, or breaks open into a sore. These need to be checked for skin cancer, and laser should not be done before the check. Read How Sun Freckles Differ from Melasma

Post-inflammatory hyperpigmentation

Appearance: Brown to dark marks where there was acne, a rash, a wound or a burn from a procedure.

Cause: Inflammation stimulates extra pigment production. It occurs easily in darker skin.

Severity/urgency: Not dangerous. It usually fades on its own over several weeks to 6–12 months if the underlying cause is controlled and you use sun protection.

When to see a doctor: When new acne or rashes keep appearing, because the cause must be treated first. Details are in Post-Inflammatory Hyperpigmentation

Nevus of Ota and Hori's nevus

Appearance: Grey-blue to grey-brown spots or patches. Nevus of Ota is usually on one side and may come with colour in the white of the eye. Hori's nevus usually appears as small spots on both cheekbones in adulthood.

Cause: Pigment-producing cells sit in the dermis. It is not caused by excess pigment production as in typical melasma.

Severity/urgency: Not urgent, but it is often mistaken for dermal melasma, so people apply melasma creams for a long time without any fading.

When to see a doctor: When the colour is unchanged after 3–4 months of melasma cream, or when there is colour in the white of the eye as well.

Dark skin from whitening creams and cosmetics

Appearance: Skin that darkens after long-term cream use. Some people develop small blue-grey spots (exogenous ochronosis), some develop a net-like darkening around the face (Riehl's melanosis), and some have thin, red skin from steroids.

Cause: Hydroquinone used continuously for too long, steroids not listed on the label, mercury, or allergy to fragrance and other cosmetic ingredients.

Severity/urgency: Not an emergency in most cases, but continuing to apply the cream makes it worse, and stopping steroids suddenly can cause a rash flare, so a doctor should plan how to stop.

When to see a doctor: As soon as you feel that a cream makes your face red, stinging or darker, and bring the cream for the doctor to see.

Sun protection for people with melasma

Sunscreen is part of the treatment, not an optional extra. Without it, topical medicine and laser results are usually hard to maintain.

Choose SPF 50 or higher, PA++++ and preferably a tinted sunscreen containing iron oxide, because visible light can trigger melasma in Asian skin.
Apply about two finger-lengths to the face and neck 15 minutes before going outside, and reapply every 2 hours when outdoors.
Wear a wide-brimmed hat, avoid the sun from 10:00 to 16:00, and apply it even when driving or sitting by a window.

Read more on choosing one in How to Choose a Sunscreen

Topical melasma treatment: drug names, strengths and duration

Topical medicine is the main treatment for most melasma. The doctor chooses according to the type of melasma, pregnancy and skin sensitivity. The information below is to help you understand the treatment plan. Choosing and prescribing drugs is the doctor's responsibility.

Triple combination cream: hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01%, applied only to the melasma area once a day at bedtime for about 8 weeks, after which the doctor reassesses to taper down. Mild redness and peeling may occur at first.
Hydroquinone 2–4%: applied at bedtime, with clear results at 8–12 weeks. Use continuously for no more than 3–4 months, then take a break or switch. It should be used under a doctor's guidance. If the skin around the melasma turns pale in a ring or stings a lot, stop and come back for a check.
Azelaic acid 15–20%: applied twice a day for 12–24 weeks. Suitable for people who also have acne. Temporary stinging or itching may occur at first.
Tretinoin 0.025–0.05%: works slowly and often needs up to 24 weeks. Do not use it when pregnant or planning a pregnancy.
Cysteamine 5%: applied for 15 minutes and then washed off, once a day for 16 weeks. An alternative when hydroquinone should not be used.
Add-on medicines: kojic acid 1–4%, niacinamide 4–5% and topical tranexamic acid 2–5% are used as supplements or during the maintenance phase.

What decides whether it is helping is the colour and area of the melasma compared with the start, at weeks 8–12. If nothing has moved, the doctor will review the diagnosis and the sun protection, and change the plan. You can compare the main drugs in Hydroquinone, Tranexamic Acid and Cysteamine: What Is the Difference?

Oral tranexamic acid for melasma

Oral tranexamic acid is an option for moderate to severe melasma or melasma that resists topical treatment. It is an off-label use, so the doctor must always take a medical history first.

Dose commonly used in studies: 250 mg twice a day for 8–12 weeks, with results starting to appear around weeks 4–8, used together with topical medicine and sunscreen.
Do not use, or use with caution: past blood clots, stroke or heart disease, current use of combined hormonal contraceptive pills, heavy smoking, pregnancy or breastfeeding.
Symptoms that mean you must stop the drug and see a doctor immediately: pain and swelling in one calf, chest pain, difficulty breathing, or sudden blurred vision.
After stopping: melasma may return within a few months if topical medicine and sunscreen are not backing it up.

Lasers and procedures available at the clinic

Laser is an add-on when topical medicine and sunscreen for 8–12 weeks are still not enough, or for mixed and dermal melasma that resists medicine. It is not first-line treatment, and no laser clears melasma permanently in a single session. Results differ from person to person, and several sessions together with topical medicine are usually needed.

Picosecond laser

Delivers energy in a very short pulse to break pigment into tiny particles, with little heat build-up. For melasma, a low-energy mode is used, spaced about 2–4 weeks apart. With different settings it is also used for freckles and some deep-layer birthmarks.

Radiofrequency microneedling (RF microneedling)

Delivers radiofrequency energy into the dermis through fine needles. There is early evidence that it may help melasma that has tiny blood vessels involved or does not respond to other methods. The evidence is still limited, so it must be assessed case by case.

Vascular laser

Considered only in cases where visible tiny vessels or redness accompany the melasma. It addresses the vascular component and is not the main way to reduce pigment.

Fractional laser

Not an early choice for melasma, because skin injury can trigger dark marks and make melasma darker in darker skin. The doctor considers it only in suitable cases.

Who should postpone or avoid laser

Pregnant or breastfeeding: it should be postponed.
Sunburnt skin or recent heavy sun exposure.
Infection or an inflamed rash in the area to be treated, such as an active cold sore.
Taking photosensitising medicine or having recently taken isotretinoin. Always tell the doctor first.
A history of raised scars or keloids, or severe post-inflammatory dark marks.
Marks that have not been diagnosed, such as a spot that is growing quickly or has uneven colour, should be examined first and may need a biopsy.

Melasma itself is not a condition treated by surgery. Surgery is appropriate only when a suspicious mark has to be removed and sent for biopsy.

Side effects and aftercare following procedures

Possible effects: Redness, warmth and mild swelling for a few hours up to 1–2 days.
Risks to be aware of: temporary darkening of melasma or return darker than before (rebound), post-inflammatory dark marks, patchy white spots (guttate hypopigmentation) if treatment is too frequent or the energy is unsuitable, and, uncommonly, wounds or blisters.
Care: Cleanse gently, apply moisturiser, use sunscreen every day, avoid scrubs and exfoliating acids for about 3–5 days or as the doctor advises, and continue the topical medicine the doctor prescribed.
Return to the doctor if: there are blisters, pus, increasing pain, or marks that keep getting darker 2–4 weeks after treatment.

Why melasma comes back, and long-term control

Melasma is a chronic condition. The pigment-producing cells in the area remain easily triggered even after the colour has lightened. Common reasons for recurrence are:

Not applying enough sunscreen, or using an untinted one, especially while travelling or working outdoors.
Hormones are still a trigger, such as the contraceptive pill or pregnancy.
Stopping the melasma medicine abruptly right after the colour fades, with no follow-up plan.
Laser that is too frequent or too strong, causing inflammation.
Using irritating creams, or rubbing and scrubbing the face hard.

Once the colour has lightened to the goal, the doctor usually tapers the main medicine down to a maintenance medicine that is safer for long-term use, and schedules reviews at intervals. In general, the first phase of treatment takes about 3–6 months, while sun protection has to continue.

Your examining doctor

Dr. Patara Voravutinon is a dermatologist, medical licence no. 54323. He holds the board certificate in dermatology and completed residency training at the Institute of Dermatology, Department of Medical Services. Readers can check the doctor's name and licence number on the Medical Council of Thailand website.

Melasma examination and every decision about drugs or procedures are made by the doctor, based on your melasma type, history and contraindications.

Consultation hours and how to prepare

Monday, Tuesday, Thursday, Friday: Consultation 16:00–20:00.
Wednesday: The consultation clinic is closed.
Monday–Friday 16:00–20:00: Laser and dermatologic surgery.
Saturday–Sunday: Open 08:00–16:00.

For a first visit, come in a state where makeup can be removed easily, bring every cream and the list of medicines you are using, tell the doctor if you are pregnant or planning a pregnancy, and call ahead to confirm the consultation time on +66 61 448 7000.

Getting here from Bangna, Bearing and Samrong

From Bangna: From Central Bangna it is about 9.5 kilometres, roughly 12–15 minutes by car in normal traffic, to Thepharak Road.
From Samrong: Take the Yellow Line from Samrong Station to Thipphawan Station, 1 stop, then walk or take a ride for about 750 metres.
From Bearing: Take the BTS from Bearing Station to Samrong Station, then change to the Yellow Line to Thipphawan Station.
From central Samut Prakan: Use Thepharak Road as the main route.

Actual travel time depends on traffic, especially in the evening, which coincides with consultation hours. Allow extra travel time.

In brief

Siam Dermatology, a dermatology specialist clinic, is on Thepharak Road, Mueang Samut Prakan, about 9.5 kilometres from Central Bangna.
The examining doctor is Dr. Patara Voravutinon, Dermatologist, licence no. 54323. The consultation clinic is closed on Wednesday.
First work out whether it is epidermal, dermal or mixed melasma, or a condition that looks like melasma, because the treatment differs.
Tinted sunscreen and topical medicine are the foundation. The triple combination cream is used for about 8 weeks, with results assessed at 8–12 weeks.
Laser is an add-on. It needs a doctor's assessment, carries risks, and results depend on the individual.
A spot that grows quickly, has uneven colour or becomes a sore should be examined before any treatment, in every case.

Frequently asked questions about the melasma clinic in Samut Prakan and Bangna

Where is the melasma clinic in Samut Prakan–Bangna with a dermatologist?

Siam Dermatology, a dermatology specialist clinic, is at 536/1 Moo 3, Thepharak Road, Thepharak Subdistrict, Mueang Samut Prakan District, Samut Prakan 10270. It is about 9.5 kilometres from Central Bangna and about 750 metres from Thipphawan Station on the MRT Yellow Line. The examining doctor is Dr. Patara Voravutinon, Dermatologist, licence no. 54323.

Which days can I be examined for melasma? Is it open on Wednesday?

The consultation clinic is open Monday, Tuesday, Thursday and Friday from 16:00 to 20:00, and closed on Wednesday. On Saturday and Sunday the clinic is open 08:00–16:00. Laser and dermatologic surgery on weekdays run from 16:00 to 20:00. Because hours may change on public holidays, please call +66 61 448 7000 before travelling.

Does this kind of melasma need laser, or is topical medicine alone enough?

Most melasma starts with tinted sunscreen and topical medicine, such as the triple combination cream for about 8 weeks, or azelaic acid 15–20% for 12–24 weeks. Low-energy picosecond laser is an add-on when 8–12 weeks have passed and it is still not enough, or for mixed and dermal melasma that resists medicine. It has to be done together with topical medicine, and there is a risk that melasma gets darker, so the doctor must always assess first.

How many months does melasma treatment take to show results?

In general, changes start to show at 8–12 weeks, and the first phase of treatment usually takes about 3–6 months. Epidermal melasma usually responds faster, while dermal and mixed melasma take longer and may not fade completely. If the colour has not moved after a full 12 weeks of medicine, the doctor will reconsider the diagnosis, because it may be a deep-layer birthmark or darkening from creams rather than melasma.

Why did melasma come back after treatment?

Because melasma is a chronic condition. The pigment-producing cells stay sensitive to sunlight, hormones and inflammation even after the colour has faded. Common causes are too little sunscreen or an untinted one, continuing the contraceptive pill, stopping the medicine immediately after the colour fades, and laser that is too frequent. Lowering the chance of recurrence means daily sunscreen, controlling triggers, and letting the doctor adjust the long-term maintenance medicine.

Without a car, how do I get to the clinic from Bangna or Bearing?

From Bearing, take the BTS to Samrong Station, then change to the MRT Yellow Line to Thipphawan Station, 1 stop, and then walk or take a ride about 750 metres to the clinic on Thepharak Road. From Bangna, if you take a ride from Central Bangna, the distance is about 9.5 kilometres and takes about 12–15 minutes in normal traffic, but allow extra time in the evening.