New Study Finds Combination Melasma Treatment Is Safe & Effective

You may have heard the hype about combination melasma treatments being the gold-standard of care. However, you may have concerns over whether combining multiple medications into one cream is safe. A recent study has found that a new combination of melasma-blasting ingredients can treat this condition safely and effectively – without the adverse effects of current treatment options.

Hydroquinone + Retinoid + Steroid = ?

The typical combination treatment for melasma combines a hydroquinone (the lightening agent), a retinoid to increase skin cell turnover, and a steroid to decrease skin inflammation.

Although this treatment is effective, hydroquinone may not be the best lightening agent for every person with melasma. Some people may experience side effects from this formulation. These include skin atrophy from the steroids and ochronosis (bluish black discoloration) from the hydroquinone. These side effects are why you cannot apply a strong melasma treatment indefinitely.

A long-term treatment option is needed, especially for people who have recurring melasma or whose melasma is stubborn.

Luckily, there are a lot of smart scientists working to figure out the optimal combination of ingredients. These scientists wondered if another formulation could effectively treat melasma without the adverse effects from long-term use.

An Alternative To Hydroquinone And Steroids

A recent study, published in the Journal of Clinical and Aesthetic Dermatology by one of our founding physicians, determined the safety, efficacy, and tolerability of a new combination melasma formulation. The formulation did not include hydroquinone or a steroid in order to avoid the side effects mentioned earlier. Instead, this combination cream included tazarotene, azelaic acid, tacrolimus, and micronized zinc oxide.

Let’s review how these ingredients work together as part of a combination melasma treatment:

• Azelaic acid: A skin lightening agent that interrupts melanin production, reducing the appearance of dark patches on the skin.
• Tacrolimus: A non-steroidal anti-inflammatory medication that decreases skin irritation.
• Tazarotene: A retinoid that increases the penetration of azelaic acid and increases cell turnover to reveal clear skin.
• Zinc oxide: A sunscreen ingredient that blocks UV radiation, preventing melasma from getting worse

During the study, the participants applied the new cream once a day for 20 weeks. The outcomes were measured as changes in Melasma Area and Severity Index (MASI) score and Melasma Quality of Life Scale. The MASI score was used to track the severity of melasma over the course of the study. The Melasma Quality of Life Scale was used to see how the treatment affected participants’ emotional and psychological well-being.

The results were clear. The new combination treatment significantly decreased melasma severity as evidenced by lower MASI scores at week 20. Study participants also reported an improved quality of life.

The treatment was well-tolerated, with the most common side effects reported as stinging and burning during application. However, these side effects decreased with continued use.

Learn more:

• Azealic acid
• Tacrolimus
• Tazarotene
• Zinc oxide

Useful Links

• Melasma Symptoms, Causes & Treatment Explained
• Can Melasma be Prevented?
• Tips for Managing Melasma
• Sun Safety Tips

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.