Melasma – an acquired condition that results in hypermelanosis of the skin – is a common condition among women that is notoriously difficult to treat. However, it is manageable and can be helped with the right topical treatment. While there is no cure for being susceptible to developing melasma, the appearance of hyperpigmentation can be reduced. This is accomplished through a combination of topical treatments and vigilant sun protection.

Many ingredients have been studied as melasma treatments with varying results. Some ingredients have been used consistently over the years and are recognized by dermatologists as being mainstays in melasma treatment. A topical treatment like a cream is ideal for treating melasma because the condition only affects skin cells. The most effective melasma cream is one with a combination of ingredients.

Top 5 Melasma Cream Ingredients

There is no one universally effective treatment for melasma. Different ingredients work better for each individual. However there are some ingredients that are consistently more effective. These are the top 5 melasma cream ingredients based on prescriptions we receive from dermatologists.

1. Hydroquinone: A lightening agent that reduces the appearance of hyperpigmentation. It inhibits the enzyme tyrosinase, which is essential to the production of melanin. Besides affecting production of melanin, hydroquinone also causes necrosis of melanocytes.
2. Retinoic Acid: Retinoic acid both increases cell turnover and affects melanin production. In a melasma cream, it helps remove hyperpigmented cells to encourage the growth of new, normally pigmented cells.
3. Kojic Acid: This ingredient is derived from certain fungal species. It also inhibits the production of tyrosinase.
4. Azelaic Acid: Azelaic acid was first used to treat acne but is now used to treat a variety of hyperpigmentation conditions. It selectively targets abnormal melanocytes so it does not have an effect on normally pigmented skin.
5. Tranexamic Acid: Tranexamic acid is quickly becoming recognized by dermatologists as an effective alternative to hyrdoquinone. Studies have shown topical tranexamic acid has similar efficacy with a reduced incidence of adverse effects.

Other ingredients include vitamin B3 and vitamin C, which can be added to any melasma formulation.  Most patients find that a combination of these ingredients in one melasma cream is most effective. A compounding pharmacy can provide a cream that combines hydroquinone, retinoic acid, kojic acid, and azelaic acid.

Melasma Cream Side Effects

The more effective topical creams usually result in some mild irritation. Often the irritation will be most noticeable when treatment is started. It will subside somewhat as the skin gets used to the ingredients. Keeping the skin moisturized and protected from the sun is essential for treatment to be successful. Hydrocortisone is added to a melasma cream to reduce irritation.

Melasma, since it is not a curable condition, requires a long-term treatment plan. A melasma cream is prescribed to get a flare-up under control. However, proper sun protection used daily reduces the severity of this condition.