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Medical Author:

Nili N. Alai, MD, FAAD

Nili N. Alai, MD, FAAD

Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What is melasma? What are signs of melasma?
• What causes melasma?
• Where is melasma seen on the body?
• What are the types of melasma?
• How is melasma diagnosed?
• What is the treatment for melasma?
• What melasma treatments can I have at my doctor's office?
• Do lasers work for melasma?
• How does hydroquinone work in melasma?
• Are there non-hydroquinone alternative treatments for melasma?
• What is Tri-Luma?
• What SPF is recommended for melasma?
• Can melasma be prevented?
• What is the prognosis for melasma?
• Melasma At A Glance
• Patient Comments: Melasma - Causes
• Patient Comments: Melasma - Location on Body
• Find a local Dermatologist in your town
• Melasma Index

Researchers believe that the hydroxyphenolic chemical (HQ) blocks a step in a specific enzymatic pathway that involves tyrosinase. Tyrosinase is the enzyme that converts dopamine to melanin. Melanin gives skin its color.

Azelaic acid is a non-hydroquinone cream that can be used to treat melasma. Studies have reported that 15%-20% azelaic acid was very effective and safe in melasma. There are no major complications reported with azelaic acid. Possible minor side effects include itching (pruritus), redness (erythema), scaling (dry patches), and a temporary burning sensation that tends to improve after 14-30 days of use.

Tretinoin cream (Retin A, Renova, Retin A Micro) is a non-hydroquinone cream used to treat melasma. Most often, tretinoin is used in combination with other creams like azelaic acid or hydroquinone. Mild localized side effects are fairly common and include peeling, dry skin, and irritation. Overall, melasma may respond slower to treatment with tretinoin alone than with hydroquinone.

Other retinoid creams include tazaratone and adapelene. These are prescription creams used much like tretinoin (Retin A).

Tri-Luma is a combination prescription cream containing fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%. It is used to treat melasma and other skin discoloration. Results may be seen in usually about six to eight weeks from starting treatment. Tri-Luma should not be used for prolonged periods exceeding eight weeks without your doctor's recommendation. It should not be used by pregnant or breastfeeding women unless specifically instructed by your physician.

Other combination creams include the Kligman formula which is a triple cream including a retinoid, a hydroquinone, and a topical steroid (for example, fluocinolone acetonide 0.01%, hydroquinone 8%, and tretinoin 0.1%). These triple combination creams may be compounded in different strengths by specialty pharmacists according to a physician's prescription. Triple creams are highly effective for melasma.