Melasma - Comparison of all treatment options

Hydroquinone

Availbale usually as a cream usually as 2% or 4%

Often used as a first line treatment. One of the most effective treatment available today.

Usually used for 1-2 months. Should never be used more than 3 months at a stretch without consulting a dermatologist. Stop using if no effects by then.

Just apply once or twice daily over the black spots. Avoid using over normal surrounding skin. If applied at bedtime, you may keep it overnight.

If applied in excessive amount, it may cause redness and dryness of skin. And if it is continued for long duration like more than 6 months, a different type of pigmentation appears (ochronosis), which is very difficult to treat.

$

Triple combination cream

Combination of hydroquinone, tretinoin and fluocinolone (a mild steroid)

Often considered as "Gold standard", it is most effective among the creams.

Due to chance of side effects, should not be used more than a month, specially not without prescription.

Usage is similar to hydroquinone. However, due to presence of tretinoin, sometime there can be irritation. To minimize it you can use a non-comedogenic moisture before, during or after triple combination cream use.

If used in-appropriately without prescription (such as for long duration, it may cause steroid damage over skin such as thinning, unwanted hair growth, excessive acne, redness and many other problems.

$

Other de-pigmenting cream

Kojic acid, azaleic acid glycolic acid, arbutin, niacinamide etc are available as cream forms often in different combinations.

While not as effective as the upper two, they can be used for much longer duration.

Can be used for many months and even for years, without risk of any significant side effects.

Usage is similar to upper two. Can be used multiple times every day.

Mild irritation and redness can occur though not very common.

$

Chemical peels

Chemical peels such as glycolic acid , salicylic acid, lactic acid peels or TCA peels are usually used for treatment of superficial melasma.

Usually used for treatment of superficial melasma. For deep dermal melasma, peels should better be avoided specially in Indian skin as there is chance of skin damage and more pigmentation thereafter.

Usually a few sittings are required, spaced by few weeks.

Done by dermatologists. You should follow the post-peel procedure very carefully as violating them may cause damage to your skin.

It is risky in Indian (darker skin) skin as there is more chance of pigmentation from the procedure itself. So usually used only when creams does not give satisfactory result.

$$

Laser

Different types of lasers are used. Most commonly used is Low-fluence Q-switched (LFQS) Nd-YAG laser

While being very effective, chance of side-effect is also very high. Considering the harmless nature of the disease, Laser is usually given as a last resort (third line treatment)

Multiple sittings are usually required.

Performed by dermatologists.

Might cause burning sensation and redness. If there is actual burning , proper treatment is required at the earliest so follow your dermatologist's direction carefully.

$$$

Microneedling

Microneedling is a cosmetic procedure performed by dermatologists usually using a derma-rollar

Micronedling is usually used along with other procedures such as chemical peels or hydroquinone creams and seem to increase the effectiveness of the original treatment.

Multiple sittings are usually required.

Performed by dermatologists.

pain and redness are most common problems followed by a microneddling session. An ice-pack would help to reduce those problems.

$$

Tranexamic acid tablet

Available as a oral tablet. Tranexamic acid is originally used for bleeding disorders. For melasma dosage is much lower. However topical tranexamic acid formulations are also available.

Usually used as an additional treatment to some existing therapy.

Usually given for few months.

Usually taken as an oral tablet. Must be prescribed by a dermatologist.

Tranexamic acid is originally given for bleeding problems so chance of side effects are there. Usually your dermatologists will perform certain laboratory tests before prescribing this medicine to minimize the chance of side effects.

$

Natural therapies

Vitamin C, E, tea-tree oil etc has been used in the treatment of melasma.

Once melasma is established such treatments have very limited role.

Can be used for long duration

Can be used just like other cosmetic products. No specific instructions.

Not much side effect unless you are allergic to a specific ingredient.

$