This compound works by inhibiting tyrosinase which prevents the conversion of DOPA to melanin.It also directly leads to melanocyte destruction and melanosome degradation. Prolonged use can cause irritant dermatitis in some individuals and chronic use can lead to exogenous ochronosis .
Topical retinoids improve melasma by promoting keratinocyte turnover and can be used in patients with photoageing for improvement of rhytides.
Niacinamide inhibits melanosome transfer to keratinocytes hence decreasing pigmentation. Both ascorbic acid and kojic acid can inhibit tyrosinase activity and have been shown in small studies to lead to decreased pigmentation. Another natural compound, azelaic acid is effective in improving pigmentation by inhibiting tyrosinase activity. It is derived from the yeast, Pityrosporum ovale and also has anti-inflammatory effects.
In conjunction with depigmenting agents is very helpful in improving the results of the treatment.
Non-ablative lasers are preferred for the treatment of melasma over ablative as they have a lesser tendency to cause less post-inflammatory pigment alteration (PIPA). They help in permanently reducing the size of melanocytes and melanosomes. We at DSHS utilize SPECTRA GOLD, one of the pioneers in Q switched Laser and the only FDA approved laser for Melasma.
- Soy , Arbutin or licorice has also been found to be efficacious in removing pigment.
- Chemical Peels Glycolic acid (35 -50%), TCA 15% , Mandelic acid are a few agents which are a useful adjuvant in improving the results. Yellow peel is very helpful in improving the results.