Dr. Desai: I will preface my overview of melasma by saying that the majority of patients who I see for melasma end up on multiple combination therapies; I rarely have a melasma patient on monotherapy. I think that’s one of the things that becomes challenging for most dermatologists; they are not really used to doing combination therapies for melasma.
First-line treatments are topical, especially topical lightening agents and the prototypical one is hydroquinone. Not to be missed is the incorporation and use of topical retinoids, specifically tretinoin, adapalene, and tazarotene, along with low-potency and high-potency topical steroids.