Using the 4% skin care system plus 0.05% tretinoin to treat moderate or marked melasma can significantly reduce the severity of melasma and the intensity of melasma pigmentation within four weeks. An improved quality of life and high levels of patient satisfaction were reported, and the treatment was generally well tolerated. Although this study was open label, and therefore potentially at risk of investigator and patient bias, the results are consistent with those from masked studies.