Utilizing combination therapy to optimize melasma outcomes.

Melasma is a chronic and recurrent disorder. It has been underdiagnosed and undertreated due to lack of effective therapies and the perception that it is merely a cosmetic nuisance. Hydroquinone, corticosteroids, licorice extracts and kojic acid have been used as monotherapy to treat melasma. However, the present standard of care in melasma therapy is combination therapy. To date, the most effective treatment is a triple-combination agent that contains hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01%. In clinical trials, its use led to complete or near-complete clearing of melasma in 8 weeks. A long-term study demonstrated its continuing efficacy and safety for as long as 360 days. In an examination of quality of life parameters, patients using the triple-combination cream showed significant improvements in self-perception by all 1290 patients. Various combinations of melasma therapy, such as chemical peels, particularly as adjuvants to the triple-combination cream, are discussed.