Treatment

Seek expert advice.

This condition is difficult to treat.

• patients with melasma should use a sunscreen effective against both UVA and UVB with sun protection factor of 15 or greater; also should avoid the midday sun
• physical treaments include:
  • laser treatment has little to offer in the treatment of this condition (1)
  • chemical peels - there has been reported improvement in patients treated with glycolic acid peels
• topical treatments include:
  • hydroquinone - this is the most commonly used treatment for melasma (2)
    • triple combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% and is currently the only FDA-approved drug for the treatment of melasma - it is the only FDA-approved agent containing hydroquinone (2)
  • tretinoin - works very slowly - the lightening of the melasma is often not apparent until afte 24 weeks of treatment
  • azelaic acid - this has been shown to be an effective treatment for melasma - of the three topical treatments described, it is the easiest to use and best tolerated (1)
  • intense pulsed light therapy has been used to treat melasma (3)

Reference:

• (1) Dermatology in practice (2001), 9 (5), 20-21.
• (2) Gupta AK et al. The treatment of melasma: A review of clinical trials Journal of the American Academy of Dermatology 2006; 55(6): 1048-1065
• (3) Journal of the American Academy of Dermatology 2008; 58 (2): Supplement 2, AB116