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This medication requires a prescription from your doctor.
Azelaic Acid 20%, Retinoic Acid 0.05%, Tacrolimus 0.1%, and Zinc Oxide 10%
Combination treatment is often the most effective for managing flare-ups of melasma. Certain ingredients have a synergistic effect when they are combined. A compounding pharmacy is able to provide combination melasma creams with multiple effective ingredients in combinations and strengths that are not commercially available. This formulation contains four ingredients in one cream: azelaic acid, tretinoin, tacrolimus, and zinc oxide.
ARTZ Melasma Cream Ingredients
Azelaic acid 20% has been shown to be as effective as hydroquinone 4% and causes fewer side effects. Tretinoin can enhance the effects of azelaic acid. Azelaic acid is effective for treating melasma because it inhibits tyrosinase and also has anti-inflammatory properties. Azelaic acid is an FDA-approved medication for the treatment of acne. However it is not available commercially in a formulation with retinoic acid, tacrolimus, and zinc oxide.
Retinoic acid, also called Tretinoin, is well-known vitamin A derivative that is included in many professional skincare products. It helps increase epidermal cell turnover and also inhibits tyrosinase activity. It has a synergistic effect when combined with azelaic acid. It is always important to wear sunscreen when you have melasma. However it is especially important when using skin lightening agents like tretinoin as they can make the skin more sensitive to UV radiation.
Tacrolimus is a safe and effective alternative to topical corticosteroids. It has been used for treating conditions like atopic dermatitis. Repeated application of corticosteroids to the skin can potentially lead to both local and systemic side effects. These side effects can vary between patients. Tacrolimus is as effective as hydrocortisone as an anti-inflammatory but may produce fewer side effects.
Zinc Oxide is the main ingredient in mineral-based sunscreens. Many individuals prefer to use mineral-based sunscreens because they do not want to be exposed to chemicals found in other sunscreens. Besides its photo-protective effects, zinc also has some inhibitory effects on melanin synthesis. However the inclusion of zinc oxide in this formulation is not a reason to not use sunscreen! Mineral sunscreens that have an SPF 30 or higher use greater than 10% concentrations of zinc oxide – up to 23-25% in some formulations. In addition, if this cream is applied before bed the sun protecting effects will not be as relevant. It is included in this formulation for its ability to assist in the inhibition of melanin synthesis.
Mild to moderate side effects of erythema and dry skin may occur when using ARTZ melasma cream, as is the case with most lightening creams. While the cream is usually prescribed to be used daily before bedtime, the dermatologist may offer an alternative dosing regimen if a patient is experiencing sensitivity to the treatment.
Evaluating the Efficacy, Safety, and Tolerability of the Combination of Tazarotene, Azelaic Acid, Tacrolimus, and Zinc Oxide for the Treatment of Melasma: A Pilot Study – Journal of Clinical and Aesthetic Dermatology
Comparison of efficacy of products containing azelaic acid in melasma treatment. – Journal of Cosmetic Dermatology
Zinc therapy in dermatology: a review. – Dermatology Research and Practice
Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis – Journal of Allergy and Clinical Immunology