What kinds of treatment did you receive for your melasma?
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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.
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.