Out of the Dark: The Medical Management of Melasma

Melasma is a relatively common form of largely gender-specific epidermal hyperpigmentation associated with a number of environmental and physiologic risk factors and triggers. In susceptible individuals with a history of melasma, both prevention (with sunblock, because solar radiation is a primary trigger) and treatment are indicated. Hydroquinone (HQ), often used in combination with other agents (eg, tretinoin and topical corticosteroids), is the standard of care for melasma. However, as of late there have been concerns regarding the side effects associated with HQ use. The US Food and Drug Administration has proposed withdrawing HQ products that have not been studied as investigational new drugs. A number of other therapeutic options exist for melasma treatment, including azelaic acid, tretinoin, topical corticosteroids, and chemical peels, used either separately or in various combinations. In a number of clinical trials, azelaic acid has demonstrated results comparable to those seen with HQ.