The use of topical steroids as a single agent to treat melasma is therefore not encouraged. It was noticed that hydroquinone itself was not sufficiently efficacious to accomplish lightening in some hyperpigmentary disorders. Theoretical consideration for the synergistic effect of these chemicals in lightening the skin were raised, but no mechanism of action was clearly established. However, this combination does give rise to the side effects of all 3 components. AHAs have been used to treat melasma.
Treatment involves a series of peels in progressive concentrations.
For better results, it has been recommended that AHA chemabrasion be accompanied by the use of hydroquinone and sunscreens. AHAs cause transient, mild stinging. In higher concentrations for peeling, erythema which lasts for a few days may develop. Scarring, hyperpigmentation and hypopigmentation are possible reactions. Experience of the therapeutic potential of AHAs in melasma treatment is still evolving, Azelaic acid Azelaic acid has been shown to be effective in melasma.