Melasma is a common, acquired, circumscribed hypermelanosis of sun- exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. The most common locations are the cheeks, upper lips, the chin, and the forehead, but other sun-exposed areas may also occasionally be involved.The main causative factors among the male melasma patients appeared to be sun-exposure and family history. Mustard oil application could also contribute to this condition.Most Indian patients do not like to use sunscreens due to oily sticky nature.Chemicals in sunscreens absorb light energy and release heat as exothermic reaction. This causes heat on face which is not well tolerated by patients .Physical sunscreens do not release heat but whitening on face is a disadvantage. Sunscreens can be mixed with calamine lotion or zinc to minimize these side effects.
We studied new triple combination of 2% hydroquinone, 0.05% Tretinoin and 0.01% fluocinolone acetonide cream with glycolic acid peels, in the treatment of melasma.The results were noted after four peels, in the form of more than 50% improvement in pigmentation in five out of 10 patients. Two patients showed more than 75% improvement.
Approach By Dermatologist
History and examination
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Sunscreens
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Mometasone based triple cream for 4 - 8 weeks + Glycolic peels
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Fluocinolone or hydrocortisone based triple creams + peels 3 - 6 months
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Oral antioxidants vitamin C ,E ,pine bark extract
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Fluocinolone based triple creams twice a week for 3 - 4 mths
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Non hydroquinone non steroid creams kojic acid, vitamin c ,arbutin etc