<p>Melasma is an acquired hyperpigmentation disorder that manifests as symmetrical light- to dark-brown patches or macules in sun-exposed areas. Treatment remains a clinical challenge. Objectives were to compare the efficacy and safety of trichloroacetic acid (TCA) 20% peeling versus either cryopeeling or topical tranexamic acid combined with microneedling in treatment of melasma. Forty patients with bilateral symmetrical melasma were recruited in a randomized controlled split-face study. Patients were divided into two groups: group I (20 patients) right side of face (group I A): received TCA 20% peeling, and left side (group I B): received cryopeeling (liquid nitrogen); both were done every two weeks for 3 months. Group II (20 patients): right side of face (group II A): received TCA 20% peeling every two weeks for 3 months, and left side (group II B): received microneedling and topical tranexamic acid (TXA) every month for 3 months. For patients who received TCA 20% or TXA, Hemi-MASI score significantly decreased (<i>p</i> &lt; 0.001 for both), but those who received cryopeeling did not significantly improve (<i>p</i> = 0.096). The TCA 20% and TXA did not differ significantly. On comparing the TCA 20% and TXA groups to the cryopeeling group, the TCA 20% and TXA groups showed a significantly greater degree of improvement. Following treatment, all three groups showed a significant decrease in dermoscopy scores (<i>p</i> &lt; 0.001), with no discernible differences. We concluded that both TCA 20% peeling and microneedling combined with topical TXA are safe and effective methods for the treatment of melasma with no significant difference between them.</p>