From the Guidelines
The recommended treatment for melasma is Platelet-Rich Plasma (PRP) therapy, which has been shown to be effective in reducing the appearance of melasma and improving skin quality and texture, with a significant reduction in MASI score and high patient satisfaction, as demonstrated in recent studies 1. The treatment of melasma should prioritize a combination of sun protection, topical agents, and procedural therapies. Daily use of broad-spectrum sunscreen (SPF 30+) is essential, as UV exposure worsens the condition.
- First-line topical treatments include hydroquinone (2-4%), typically applied once or twice daily for 3-6 months, which works by inhibiting melanin production.
- Triple combination therapy containing hydroquinone 4%, tretinoin 0.05%, and a mild corticosteroid like fluocinolone acetonide 0.01% (Tri-Luma) is particularly effective, used once daily for 8-12 weeks.
- For maintenance or as alternatives, non-hydroquinone options include azelaic acid (15-20%), kojic acid (1-4%), vitamin C, retinoids, or tranexamic acid (oral 250mg twice daily or topical 2-5%).
- PRP therapy has been shown to be more effective than intradermal tranexamic acid in the management of melasma, with a significant reduction in MASI score and high patient satisfaction 1.
- The use of PRP in combination with oral tranexamic acid can improve the treatment effect of tranexamic acid alone in the treatment of melasma, maintaining normal levels of VEGF and ET-MSH, and reducing disease recurrences 1.
- It is essential to manage melasma as a chronic condition, with regular follow-ups and an effective home care routine, including adequate sun protection 1.
From the FDA Drug Label
HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. The recommended treatment for melasma is hydroquinone (TOP), specifically a 4% skin bleaching cream, for the gradual bleaching of hyperpigmented skin conditions 2.
- Key points:
- Indication: hyperpigmented skin conditions
- Specific condition: melasma
- Treatment: hydroquinone 4% skin bleaching cream
From the Research
Treatment Options for Melasma
The treatment of melasma involves various options, including topical agents, chemical peels, laser- and light-based devices, and oral agents. According to a study published in 2020 3, triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment for melasma, as well as hydroquinone alone.
Topical Treatments
- Hydroquinone (HQ) alone or as part of a triple combination cream (TCC) is considered a first-line treatment for melasma 4
- Azelaic acid (20%) has been shown to be effective in reducing melasma, especially in mild cases 5
- Kojic acid and topical vitamin C may also be used as adjunctive treatments, although more studies are needed to establish their efficacy 4
Oral Treatments
- Oral tranexamic acid has been shown to be effective in the treatment of melasma, particularly when used in combination with topical hydroquinone 6
- Oral tranexamic acid may be used as an adjuvant to topical triple combination cream, although its role as a primary treatment is still being studied 7
Other Treatment Options
- Chemical peels and laser- and light-based devices have mixed results and may be associated with a higher risk of adverse effects 3
- Sunscreens are essential in the treatment and prevention of melasma, as they help to reduce the risk of further pigmentation 4
Key Findings
- A study published in 2023 found that HQ, TCCs, sunscreens, kojic acid, and azelaic acid receive a grade A recommendation for the treatment of melasma 4
- Another study published in 2020 found that a combination of oral tranexamic acid and topical hydroquinone is more effective than hydroquinone alone in the treatment of melasma 6