Do you think the current topical medications for melasma treatment are really helpful? I believe this is a question that many people will be concerned about, especially for some melasma patients who are not too willing to accept oral medication or laser treatment, and will place great expectations on topical medications. So today, we will focus on sharing with you the topical medication in melasma treatment and how much it can actually play a role. First of all, when it comes to topical medications, the first choice of dermatologists is usually hydroquinone cream, not only because of the long history of hydroquinone in the treatment of human hyperpigmented skin diseases (started in the United States in 1966), but more importantly because of the depigmentation effect that cannot be replaced by other topical medications. Then let’s get to know this drug first: hydroquinone, also known as hydroquinone, acts on melasma mainly by inhibiting tyrosinase, an important enzyme that can lead to the formation of macula (mainly melanin), so that the formation of melanin is reduced and the broken ring is increased, and it may directly inhibit the synthesis of DNA and RNA of melanin vesicles, so that there is less and less melanin in the epidermis and play the role of light spots. Hydroquinone, also known as hydroquinone 2, is really effective as one of the most widely used topical drugs for melasma treatment? The answer is positive, many physicians at home and abroad have done research in this area, with concentrations ranging from 1.5% to 8% in large sample clinical control studies, and the general conclusion is that the higher the concentration, the better the efficacy, but the side effects also increase, in order to balance the efficacy and side effects, the concentration commonly used in China is 2% to 4%. Generally, we suggest that hydroquinone cream should be used for more than 4 weeks, so that the side effects that people are concerned about may come: 1. Skin irritation in the area of application, which is the most common, occurs mostly within 2 weeks of the first use, and the incidence is about 25% when using 4% hydroquinone cream. What should I do if this happens? In fact, most people only have mild skin redness, no need to stop using; but if there is also a more obvious itching, stinging or burning sensation, there may be contact dermatitis, this time you need to immediately stop using, and see a dermatology clinic. 2, hypopigmentation or depigmentation, commonly known as “over-treatment”, this situation is now rare, the main reason is, of course, because we use a low concentration of hydroquinone, and the other is that once the use of the process of excessive skin whitening (i.e., whiter than normal skin color) should stop using. 3, the rarest together: exogenous brown yellows, which in foreign countries (brown or black race) there are some reports, mainly because the concentration is too high; intraocular pigmentation and permanent corneal damage, is also extremely rare, as long as the application of attention not to apply to the eyes can be completely avoided. 4, other: In fact, the most used topical drug in Europe and the United States is a triple drug: 4% hydroquinone + 0.05% retinoic acid + 0.01% skin relaxation, the efficacy is more certain, but the national concern is the hormone and retinoic acid contained in the long-term application of other problems, so here is no longer discussed in detail. If I am allergic to hydroquinone, is there any other choice? In clinical use, there are still some people who are allergic to hydroquinone. If I am allergic to hydroquinone, are there any other topical options? In clinical use, there are still some people who are allergic to hydroquinone. If you are allergic to hydroquinone, is there any other topical medication that you can choose? The answer is of course yes. We commonly use L-vitamin C, azelaic acid, glycyrrhetinic acid, arbutin, etc. If these are combined with moisturizing creams, not only can improve pigmentation, but also improve dry skin which is more helpful to the recovery of melasma. In general, topical drugs have a certain auxiliary role in the comprehensive treatment of melasma, and the combination of this application method can improve the effective degree of treatment of melasma or shorten the effective time of treatment, which is also one of the gospel for melasma patients.