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Certain supplements can help to speed up a slow COMT and support healthy estrogen metabolism

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Consider NAC, MSM, or glutathione if sulfur is low

5.2 Oral treatment 5.2.1 Tranexamic acid Oral tranexamic acid has been shown to be effective as an adjuvant therapy for refractory cases of melasma or as a second or third-line of treatment (Kim et al., 2017)

Functionalized chitosan nanoparticles for cutaneous delivery of a skin whitening agent: an approach to clinically augment the therapeutic efficacy for melasma treatment