What is the best cream for melasma? We asked a derm

Table of Content:
Melasma cream vs melasma treatment | How to get a prescription? | Best melasma treatment cream | Best cream for melasma | Prevention

What is the difference between a melasma cream and a melasma treatment cream?

Dr. Carolina Fernandez, board-certified dermatologist, says that the terms “melasma cream” and “melasma treatment cream” are often used interchangeably, but there is a subtle difference:

• Melasma cream generally refers to any over-the-counter cream that addresses melasma these creams and serums may help lighten pigmentation but are not necessarily formulated with prescription-strength or clinically proven ingredients.
• Melasma treatment cream typically implies a medically driven formulation, often prescribed by a dermatologist. These treatment creams usually contain active ingredients like hydroquinone, tretinoin, or compounded blends, and are intended as part of a clinical treatment plan to reduce melasma effectively.

How to get a prescription for a melasma treatment cream?

To get the a prescription for a melasma treatment cream you can have a consultation with a board-certified dermatologist via Miiskin for only $59. It takes 5 minutes to upload your photos and answer the clinical questionnaire and you will get an answer from the doctor in 1-2 days.

After I get my prescription where can I buy my melasma treatment cream?

It depends on what the dermatologist prescribes. If they prescribe a compounded treatment cream, you can buy it via third-party platform called Skin Medicinals. If you get a branded or generic formula like Tri-Luma or hydroquinone, you can buy it at any local pharmacy.

What is the best melasma treatment cream for the face?

According to Dr. Fernandez, prescription-strength melasma creams are generally more effective and deliver faster results compared to over-the-counter options. These formulations contain higher concentrations of active ingredients that target pigment production and accelerate skin cell turnover. One of the most effective treatments is the triple combination cream, which includes hydroquinone (a skin-lightening agent), tretinoin (a retinoid that promotes cell turnover), and a topical corticosteroid (to reduce inflammation and irritation). This combination is widely regarded as the gold standard for melasma treatment and is often prescribed by dermatologists.

Below, Dr. Fernandez outlines other top prescription options, in addition to the triple combination cream.

Triple combination cream for melasma

Dr. Fernandez says that one of the best treatment cream for melasma is a triple-combination cream consisting of hydroquinone, tretinoin, and a topical corticosteroid. What makes this medication so effective is that it addresses melasma from three different angles.  This melasma cream is sold under the brand name Tri-Luma, but you can also obtain a similar customized formula via a compounding pharmacy. 

Hydroquinone cream for melasma 

Hydroquinone is a skin-brightening prescription medication frequently used to address age spots, freckles, melasma, and dark spots that may have come as a result from sun exposure, inflammation, or skin damage caused by acne vulgaris. 

Tretinoin 

Tretinoin can help address problems related to excessive skin pigmentation, such as melasma and post-inflammatory hyperpigmentation. It aids in the reduction of dark spots and the attainment of a more uniform skin tone. Tretinoin can also help reduce the appearance of acne scars.  

Azelaic acid

Azelaic acid is a topical medication with antibacterial, anti-inflammatory, keratolytic (exfoliating) properties and a whitening effect, which is beneficial for patients with acne or dark spots. 

Higher concentrations of azelaic acid such as 15% and 20% require a doctor’s prescription, but topical creams with low concentrations (10%) can be bought over-the-counter.

Glycolic acid

Glycolic acid is used for melasma due to its exfoliating properties, which help remove dead skin cells and gradually lighten dark patches. It also stimulates collagen production, improving skin texture and overall appearance. Glycolic acid can enhance the effectiveness of other skin-lightening treatments and promote an even skin tone. 

What are the best melasma creams sold over-the-counter?

Dr. Fernandez says that this list provides you with the best melasma creams and serums that can be bought over-the-counter. You will need a doctor’s prescription for higher concentrations which are usually more effective. 

Thiamidol

Thiamidol is an active skincare ingredient, offering benefits including depigmentation, melasma treatment, melanin production inhibition, and prevention of new spots. It primarily acts by inhibiting melanin production, thereby contributing to skin depigmentation and the treatment of conditions such as melasma.

Tranxanemic acid for melasma

Tranexamic acid is used for melasma because it can help reduce excessive pigmentation by inhibiting the activation of melanocytes, the cells responsible for producing melanin. This acid has anti-inflammatory and anti-angiogenic properties, which can be beneficial for conditions like melasma characterized by skin inflammation and abnormal blood vessel formation. 

Tranexamic acid can be used orally or topically, under medical supervision, as part of a comprehensive treatment plan for melasma. It can help fade dark patches, improve skin tone, and reduce the recurrence of melasma when used as directed and in conjunction with other appropriate treatments and sun protection measures. 

Niacinamide

Niacinamide is used for melasma due to its skin-brightening and anti-inflammatory properties. It can help reduce the production of melanin, leading to lighter and more even skin tone. 

Niacinamide is well-tolerated and it is usually used in combination with other treatments for melasma. It also promotes skin hydration and barrier function, making it suitable for various skin types.

Kojic acid

Kojic acid is used for melasma because it has skin-lightening properties that can help reduce the appearance of dark patches associated with melasma. It works by inhibiting the production of melanin, the pigment responsible for skin color. 

Research shows that kojic acid is most effective at reducing dark spots when used in combination with hydroquinone or glycolic acid. 

Vitamin C

Vitamin C is used for melasma because it is a strong antioxidant with skin-brightening properties. Additionally, vitamin C protects the skin from damage caused by UV radiation, which is a known exacerbating factor for melasma. 

When applied topically in the form of serums or creams, vitamin C can be a valuable component of a skincare regimen for managing melasma, but as with kojic acid it shows better results in combination with other skin-lightening ingredients.

Tinted sunscreen

Sunscreen is vital for managing melasma because exposure to ultraviolet (UV) radiation from the sun can trigger and worsen this skin condition. UV rays stimulate the production of melanin, leading to darkening of melasma patches.

Can melasma be prevented?

According to Dr. Fernandez, melasma cannot be entirely prevented, but there are several measures you can take to reduce the risk of developing melasma or minimize its severity.

Protect your skin from direct sun exposure 

Minimize direct sun exposure, especially during peak sun hours (10 a.m. to 4 p.m.) and always use sunscreen with SPF 50 or higher, even on cloudy days, and reapply every 2 hours when outdoors. Use wide-brimmed hats, sunglasses, and protective clothing when exposed to the sun.

Use alternative birth control methods

Although the use of birth control pills do not worsen melasma; these pills influence your hormones, which can influence the development of melasma. This is why a medical consultation is always necessary. If you are prone to melasma, discuss the use of other birth control methods with your healthcare provider, as birth control pills may trigger or worsen the condition. 

Use adequate skin care products

Some skincare products may irritate your skin and worsen melasma. Consult with a dermatologist for a skincare regimen tailored to your skin type and melasma condition.

Stress management

Although it may be controversial, some research suggests that stress may contribute to melasma. Engaging in stress-reduction techniques such as meditation and relaxation may be helpful. 

What is the best sunscreen for melasma?

When trying to keep melasma spots at bay you should choose a broad-spectrum sunscreen with SPF 50, to shield against both UVA and UVB rays. Tinted sunscreens are particularly beneficial as they contain mineral-based ingredients like titanium dioxide and zinc oxide, which provide a physical barrier against the sun while being gentle on sensitive skin. Tinted sunscreen formulations also include iron oxide, which protects against visible light known to exacerbate melasma, and helps mask dark spots, enhancing skin appearance. Daily application and reapplication every two hours, or more frequently during swimming or sweating, combined with wearing hats and seeking shade, offer the best protection for skin prone to melasma.

What else can I do for melasma besides treatment creams?

Chemical peels for melasma

Chemical peels performed by a dermatologist can help improve melasma by exfoliating the top layers of skin, which may contain excess pigmentation. This can lead to a more even skin tone.

Laser therapy for melasma

Certain laser and light-based therapies, like fractional lasers or intense pulsed light (IPL), can be effective in reducing melasma. These treatments target the excess pigment in the skin. Laser therapies can be quite useful, especially when dealing with deep melasma which affects the dermis (second layer of the skin).

Lee este artículo en Español ¿Qué es el melasma en la cara y cuál es el mejor tratamiento?

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574745/
https://my.clevelandclinic.org/health/diseases/21454-melasma
https://www.ncbi.nlm.nih.gov/books/NBK539693/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/
https://www.ncbi.nlm.nih.gov/books/NBK459173/#:~:text=Azelaic%20acid%20is%20a%20naturally,patients%20with%20coexistent%20postacne%20hyperpigmentation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235096/
https://pubmed.ncbi.nlm.nih.gov/29677015/
https://onlinelibrary.wiley.com/doi/full/10.1111/jocd.15589
https://www.webmd.com/beauty/features/what-kojic-acid-can-do-for-your-skin
https://pubmed.ncbi.nlm.nih.gov/10417583/

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