Fade dark patches safely

Adults with symmetrical brown or grey-brown patches on the cheeks, forehead, upper lip or chin, often after sun exposure, pregnancy or hormonal contraception. The doctor confirms the pattern from your photos; an irregular, single or changing dark spot needs an in-person check instead.

Hydroquinone 4% cream, applied only to the patches for a supervised 60 to 90-day course; hydroquinone 4% gel with glycolic acid for resistant patches; or a pharmacy-compounded Kligman-type combination (hydroquinone with a low-strength retinoid, kojic acid and niacinamide) used at night, twice a week for three months. Hydroquinone is not permitted in cosmetics in the EU, so it is available only as a prescription medicine.

Yes, a clear photo is required for melasma. Take it in daylight, without make-up, showing the whole face and a close-up of the patches. It lets the doctor confirm melasma and gives a baseline to compare against at the review.

Melasma responds slowly: most people see a first change after 4 to 8 weeks, with older patches taking longer, and older patches take longer. Hydroquinone is used in limited courses because prolonged, uninterrupted use can cause a blue-grey darkening called ochronosis, so the doctor sets a stop or maintenance point. Pigment often returns after summer sun, which is why protection continues after the course.

Ultraviolet and visible light drive melasma, so any depigmenting course fails without strict protection. Use a broad-spectrum SPF 50+ every morning, ideally a tinted one with iron oxides for visible light, reapply outdoors, and wear a hat. This continues year-round, not just during treatment.

No. Hydroquinone and tretinoin are not prescribed during pregnancy, while trying to conceive, or while breastfeeding. Pregnancy-related melasma often fades on its own after delivery, and sun protection is the safe measure until then. The questionnaire checks this before you pay.

The consultation is €40, one-off; the medicine is paid at the pharmacy, and a compounded formula takes a few days to prepare. If the doctor cannot treat you online, the fee is refunded in full. At the end of the course, a follow-up consultation with new photos lets the doctor decide on maintenance, a break, or a different approach.

Apply a thin layer only to the dark patches, not the skin around them, which could lighten and leave a pale halo. Use it on clean, dry skin as the doctor directs, keep it away from the eyes and lips, and wash your hands afterwards. If the cream or gel has turned dark, do not use it and tell the doctor.

Mild burning, redness or dryness on the patches is common at first. Message the doctor in the chat if the treated skin darkens or shows blue-black marks, if irritation persists or blisters, or if you get hives, swelling or wheeze. Also tell the doctor if there is no improvement after 2 months.

It can. Hormonal contraception is a common trigger, and melasma can be harder to treat while a trigger continues. Do not stop your contraception on your own: mention it in the questionnaire and discuss other options with the doctor or clinic that prescribes it.

Chemical peels and some lasers are sometimes used for stubborn melasma, but they can also make pigment worse, especially on darker skin, and they are done in a clinic, not in this pathway. Topical treatment and sun protection come first. If patches do not respond, the doctor can refer you to an in-person dermatologist.