Melasma - Treatment

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What is the treatment for melasma?

The most common melasma therapies include 2% hydroquinone (HQ) creams like the over-the-counter products Esoterica and Porcelana and prescription-strength 4% creams like Obagi Clear, Tri-Luma, NeoCutis Blanche, and 4% hydroquinone. Certain sunscreens also contain 4% hydroquinone, such as Glytone Clarifying Skin Bleaching Sunvanish SPF 23 and Obagi's Sunfader sunscreen. Products with HQ concentrations above 2% sometimes require a prescription or are dispensed through physician's practices. Clinical studies show that creams containing 2% HQ can be effective in lightening the skin and are less irritating than higher concentrations of HQ for melasma. These creams are usually applied to the brown patches twice a day. Sunscreen should be applied over the hydroquinone cream every morning. There are treatments for all types of melasma, but the epidermal type responds better to treatment than the others because the pigment is closer to the skin surface.

Melasma may clear spontaneously without treatment. Other times, it may clear with sunscreen usage and sun avoidance. For some people, the discoloration with melasma may disappear following pregnancy or if birth control pills and hormone therapy are discontinued.

In order to treat melasma, combination or specially formulated creams with hydroquinone, a phenolic hypopigmenting agent, azelaic acid, and retinoic acid (tretinoin), nonphenolic bleaching agents, and/or kojic acid may be prescribed. For severe cases of melasma, creams with a higher concentration of HQ or combining HQ with other ingredients such as tretinoin, corticosteroids, or glycolic acid may be effective in lightening the skin.

  • Azelaic acid 15%-20% (Azelex, Finacea)
  • Retinoic acid 0.025%-0.1% (tretinoin)
  • Tazarotene 0.5%-0.1% (Tazorac cream or gel)
  • Adapalene 0.1%-0.3% (Differin gel)
  • Kojic acid
  • Lactic acid lotions 12% (Lac-Hydrin or Am-Lactin)
  • Glycolic acid 10%-20% creams (Citrix cream, NeoStrata)
  • Glycolic acid peels 10%-70%
  • Other proprietary ingredients and mixtures of ingredients as in Elure, Lumixyl, and SkinMedica's Lytera products

Possible side effects of melasma treatments include temporary skin irritation. People who use HQ treatment in very high concentrations for prolonged periods (usually several months to years) are at risk of developing a side effect called ochronosis. Hydroquinone-induced ochronosis is a permanent skin discoloration that is thought to result from use of hydroquinone concentrations above 4%. Although ochronosis is fairly uncommon in the U.S., it is more common in areas like Africa where hydroquinone concentrations upward of 10%-20% may be used to treat skin discoloration like melasma. Regardless of the potential side effects, HQ remains the most widely used and successful fading cream for treating melasma worldwide. HQ should be discontinued at the first signs of ochronosis.

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See what others are saying

Comment from: Colorado, 45-54 Female (Patient) Published: October 22

I got melasma on my upper lip in 2009. I was told IPL (intense pulsed light) treatments would remove it. The IPL treatments made it worse. I was then told that Fraxel laser would remove it but the doctor would not do only my upper lip, he said I had to do my whole face. Now I look even worse and have a red and brown face with a definite line along my jaw so I look like I am wearing a mask. I have olive skin and am Caucasian. I am so upset that I took advice from a doctor without doing a small spot to see what would happen to my skin. Now I wear makeup to cover this mess. Heartbreaking that my face is such a disaster now.

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Comment from: Cal cat, 35-44 Female (Patient) Published: April 14

I"ve tried the blend of Retin A, kojic acid and hydroquinone for my melasma but won"t use when it"s summer. I use the M2 (mandelic acid) line- the serum with the cream. It worked great for my upper lip. Stay away from all lasers - that"s what caused my melasma to show up. Laura Mercier Silk Foundation, and Dior Forever cover well. I"m also using IT cosmetics BB cream with SPF 50 under foundation, and then Urban Decay setting spray.

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