BACKGROUND Melasma is a common acquired disorder of hyperpigmentation which is difficult to treat. OBJECTIVE We aim to evaluate the efficacy and safety of combined microneedling with trichloroacetic acid in the treatment of melasma. PATIENTS AND METHODS Forty women with facial melasma were included and randomly classified into 2 groups. Group A included 20 patients treated with bimonthly session of trichloroacetic acid 25% peeling (8 sessions) combined with a monthly session of microneedling (4 sessions). Group B included the other 20 patients that were treated by bimonthly trichloroacetic acid 25% peeling session (8 sessions) alone. RESULTS After 1 and 3 months of treatment, the mean melasma area and severity index, modified melasma area and severity index, and melasma severity index scores showed significant improvement in each group (p , .05 for each). At 1 and 3 months, the mean percentages of change of all scores were significantly higher in group A than group B (p , .05). CONCLUSION Combined trichloroacetic acid peel with microneedling is effective and a safe option for treating melasma.