I also advise against the use of laser, microdermabrasion, and chemical peels to treat melasma. First of all, most of these (in addition to the medications listed above) are not safe for use during pregnancy. Since many cases of melasma present during pregnancy, that is a huge red flag. Furthermore, it is the same situation where these may be great quick fixes, but cause inflammation which leads to long-term problems such as dermal thinning, degradation of collagen and elastin, and more hyperpigmentation.
There are several effective alternative treatments that are safer both short-term and long-term.
How TO treat melasma.
The first steps to take if you have melasma is to take a look at your diet and lifestyle and make the necessary changes in order to reduce the risk of Candida overgrowth and estrogenic activity in the body. It is also necessary to use proper sun protection on a regular basis, and reduce stress levels as much as possible.
Once these holistic measures have been taken, you can try a pigment fading product that contains natural lightening ingredients. The ingredient paper mulberry has been shown to be even more effective than prescription strength hydroquinone in fading melasma and hyperpigmentation, especially when used in conjunction with bearberry. Other natural ingredients that relax over-productive melanocytes (without suppressing them completely and causing photosensitivity in the skin) are watercress, mandelic acid, lactic acid, lemon peel extract, apple cider vinegar, and Vitamin C (L-ascorbic acid). Look for high quality, well formulated professional products that contain these anti-inflammatory, yet effective ingredients.
Specific skin care issues like melasma are best treated with use of a complete skin care regimen, in addition to the holistic means suggested above. If you have melasma, or any other non-threatening skin issue, it is a good idea to consult with a licensed aesthetician and/or holistic healthcare provider.