ask your pharmacist

Are there any prescription treatments for melasma?

The best way to prevent melasma is to limit your exposure to sunlight and regularly apply a sunscreen with an SPF of least 15, such as Neutrogena Sensitive Skin sunblock or Olay Daily Care moisturizer.

Hydroquinone creams, available both over the counter and in prescription-strength formulations, can help fade existing melasma spots. Doctors usually recommend prescription hydroquinone products when less-concentrated over-the-counter formulations aren’t effective. Hydroquinone is available by prescription in concentrations of 3 percent (brand name Melanex) and 4 percent (Eldoquin-Forte, Eldopaque-Forte, Solaquin Forte). It can take six to 12 weeks of treatment before you notice significant improvement. Melasma spots often reappear when you stop using hydroquinone products. Hydroquinone can make the skin very sensitive to the sun, so you should use it in combination with a sunscreen.

Tretinoin (Retin-A, Renova) is sometimes used alone or in combination with hydroquinone to treat melasma. It increases the turnover of skin cells, a process that helps reduce excess pigmentation. Tretinoin lightens melasma spots slowly over several months. The spots usually reappear after treatment stops.

Chemical peels or laser removal are other treatment options. These methods lighten dark areas immediately. They can reduce melasma in the long term for many women, but the spots may reappear for some.

If birth control pills are causing your melasma, consider switching to a birth control pill with a lower level of estrogen.

Sources:
Dover, J. “Dermatology.” Journal of the American Medical Association 273 (1995).
Contraceptive Technology. Ardent Media, 1998.
Integrative Medicine Access. Integrative Medicine Communications, 1999.
Medline Plus. Medline, 2006.
Micromedex® Healthcare Series. Thomson Micromedex, 2006.
Peirce, A. The American Pharmaceutical Association Practical Guide to Natural Medicines. William Morrow & Co., 1999.
The Natural Medicines Comprehensive Database. Pharmacists Letter Inc., 2001.

This answer prepared 6/20/2001.
This information updated 1/30/2007.