Prescription Treatments for Melasma

Melasma is a skin condition characterized by patchy dark spots on various areas of the face, including the cheeks, forehead, jawline and around the mouth. It is caused by overactive pigment producing cells (melanocytes) and can be brought on by pregnancy, birth control pills, estrogen supplements or sun exposure. While there are some over-the-counter skin bleaching or lightening creams available, prescription treatments for Melasma may be more effective.

Doctor writing a prescription (Image: BernardaSv/iStock/Getty Images)

Single-ingredient Medications

Single-ingredient topical creams contain one active ingredient that is used to decrease the dark pigmentation caused by Melasma. Hydroquinone topical creams are commonly prescribed to individuals who do not respond to over-the-counter strength treatments. Creams containing hydroquinone in greater than 2 percent concentration are available by prescription only. Hydroquinone 4 percent is generally considered to be one of the most effective treatments available.

Tretinoin (also known as retinoic acid, retinol or Vitamin A) is another popular medication available by prescription. Daily application of topical 0.05 and 0.1 percent tretinoin have been shown to reduce pigmentation; however, it can take between 4 and 6 months for tretinoin creams to begin producing any clinically significant lightening. Findings published in the April 2004 issue of "Dermatologic Surgery" suggest that treatment with 1 percent tretinoin peel (a procedure in which the acid treatment is applied to the face to remove the outer layers of damaged skin) may provide effective and faster results.

Azelaic acid is also available as a prescription-strength topical cream in 15 to 20 percent concentrations.

Combination Topical Creams

While single-ingredient medications can be effective, they may be combined with other skin lightening agents to boost their skin-lightening effect. Creams containing various combinations of two active ingredients are available by prescription for treatment of Melasma. Active ingredients typically include hydroquinone, retinol/retinoic acid/tretinoin, azelaic acid or glycolic acid. Glycolic acid is used in combination medications because it increases absorption of lightening agents into the skin. People with Melasma are advised to avoid sun exposure because sunlight can worsen the dark pigmentation, so some creams also contain an SPF to provide additional sun protection.

Prescription combination topical creams include a 4 percent hydroquinone and 4 percent glycolic acid combination (with and without SPF 15), a 4 percent hydroquinone and 10 percent glycolic acid combination, a 4 percent hydroquinone and retinol combination (with and without SPF 15), a 4 percent hydroquinone and tretinoin combination and a combination of azelaic acid with either tretinoin (0.05 percent) or glycolic acid (15 to 20 percent).

Two percent kojic acid is also sometimes combined with hydroquinone, but it may cause more skin irritation, so it is not typically prescribed as a first-line medication.

Combination Trio Medication

Another prescription medication available for treating Melasma is a combination trio of the corticosteroid fluocinolone acetonide (0.01 percent), hydroquinone (4 percent) and tretinoin (0.05 percent). The high potency of fluocinolone acetonide can cause skin thinning, so this medication can only be used for a limited amount of time under the supervision of your doctor.