What To Do When Over-The-Counter Treatments Don’t Work

If you have tried home treatments for dark spots on your skin with little success, you may be wondering what your next step is to address the problem. What should you do when over-the-counter treatments don’t work? Read on to find out.

Understanding over-the-counter melasma treatments

Topical lightening treatments for conditions like melasma and hyperpigmentation generally work by preventing the production of melanin, a biological pigment, in the treatment area. Many ingredients found in OTC topical treatments for hyperpigmentation are also found in prescription-strength formulas, just in lower concentrations.

There are a number of reasons over-the-counter treatments don’t work to clear up melasma, including:

• Concentrations of active ingredients are not a high enough “dose” to effectively lighten dark spots
• Interactions with other medication or skincare products reduces efficacy
• Ingredients in the OTC topical formula are not the right ingredients for your particular condition

Studies of over-the-counter (OTC) lightening treatments on melasma and postinflammatory hyperpigmentation indicate an improvement rate of just 26.5% according to study participants (Saade).

Are over-the-counter options safer?

Many people assume that topical treatments are safe and difficult to misuse if they are available without a prescription, which can lead to negligible results or even side effects.

Hydroquinone is a lightening agent that is considered the “gold standard” treatment for hyperpigmentation and melasma. Up until September 2020, hydroquinone was available OTC in concentrations of 2% or less in the United States.

However, the CARES Act included language requiring retailers to remove hydroquinone products from shelves to prevent misuse, especially as an all-over skin lightening treatment. Ingredients you may currently find in OTC topical formulas include kojic acid, cysteamine, ascorbic acid, methimazole, and tranexamic acid.

How lifestyle changes can help

Many people underestimate how much sun exposure can contribute to their hyperpigmentation concerns. Melanocytes – cells at the base layer of the dermis – produce melanin to protect the skin when exposed to ultraviolet light. Just one day of significant sun exposure can undo months of progress in the treatment of hyperpigmentation. Some lifestyle changes in addition to your treatment plan may help, such as:

• Avoiding excess sun exposure at peak hours when possible
• Wearing broad spectrum sunscreen
• Wearing protective clothing, i.e. hats and long sleeves
• Avoiding personal care products containing irritants or other ingredients that may counteract treatment effects

The Benefits Of Prescription-Strength Treatment

People are often reluctant to seek medically-guided prescription solutions for hyperpigmentation, as these option can be inconvenient and expensive. However, prescription-strength creams can help clear up melasma. If you’re tired of over-the-counter treatments that don’t work, a new group of online options have emerged as an alternative to traditional dermatology practices that can brings expert dermatological care to your door and remotely.

References

• Saade DS, Maymone MBC, Secemsky EA, Kennedy KF, Vashi NA. Patterns of Over-the-counter Lightening Agent Use among Patients with Hyperpigmentation Disorders: A United States-based Cohort Study. J Clin Aesthet Dermatol. 2018;11(7):26-30.

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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.