Melasma oral and topical medications: where to obtain them? Choose based on diagnosis and monitoring for side effects

Melasma oral and topical medications should be obtained from a place where a doctor examines the underlying causes of worsening, monitors for side effects, and decides on how to continue treatment.[1]This is because the more effective a topical medication is, the more likely side effects become problematic when used without a doctor's oversight.[1]The oral medication tranexamic acid has also been noted to require closer monitoring of side effects.[1].

Will they confirm whether it is melasma and identify the causes of worsening?

First, check whether the clinic examines skin and body condition before prescribing medication. Melasma is difficult-to-treat hyperpigmentation that worsens with ultraviolet rays and female hormones.[2]Sunlight, hormones, pregnancy, and constitution are cited as the main causes.[1].

Therefore, expert recommendations establish that initially identifying and treating bodily factors and implementing sun protection measures form the foundation of care.[1]Rather than just receiving medication and leaving, confirm whether the clinic will examine the causes of worsening together with you.

Before oral medication, will they ask about pre-existing conditions and your medical history?

It is also important to check whether the doctor asks about pre-existing conditions and other medications before prescribing tranexamic acid. Tranexamic acid is originally an anticoagulant and is used for melasma outside of its approved indication.[3].

Regarding concerns about blood clots (thrombosis), research examining data from many medical institutions found no reported relationship between thrombosis and melasma medication.[4]However, concerns remain,[4]and it has been suggested that closer monitoring of side effects is necessary.[1]Be honest about whether you have a history of thrombotic disease or are taking hormone medications.

Is there an explanation of topical medication side effects and duration of use?

Hydroquinone topical medication is commonly used but has side effects. Contact dermatitis is prone to occur, and prolonged use can lead to ochronosis, a condition where skin becomes bluish-black.[5]Some reports indicate this can occur with use exceeding 6 months.[6].

Prolonged use of 3–5% hydroquinone tends to cause irritation, which can paradoxically lead to post-inflammatory hyperpigmentation.[7]Tretinoin also frequently causes contact dermatitis, redness, and peeling; when used alone for melasma, it can take 20–40 weeks to show results.[7].

Combination topical medications containing hydroquinone, tretinoin, and a steroid are not recommended during pregnancy or breastfeeding.[8]If you plan to become pregnant, inform the clinic at the start.

Can you discuss how to manage treatment after improvement?

Since melasma tends to recur even after improvement, the ability to consult about maintenance is an important factor to compare. Expert recommendations include planning maintenance treatment after improvement and switching between hydroquinone-containing and hydroquinone-free medications.[1].

In a trial comparing 60 women, the effectiveness of tranexamic acid topical medication and hydroquinone was similar.[9]The tranexamic acid group showed no side effects, while 10% of the hydroquinone group experienced redness or irritation.[9]Also ask whether the clinic can switch to a different medication if one doesn't work for you.

Where to obtain medication? Guidelines when unsure

During consultation, ask about these points:

Diagnosis: Will they confirm whether it is melasma and identify the causes of worsening?[1][2]

Medical history: Before prescribing oral medication, will they ask about a history of thrombotic disease or use of hormone medications?[3][4]

Duration: Will they explain topical medication side effects and how long it should be used?[5][6][7]

Maintenance: Can you discuss maintenance treatment after improvement or switching medications?[1]

The right medication and duration of use cannot be determined from an article alone. During consultation, inform the doctor when the spots appeared, your pre-existing conditions, other medications you take, and your pregnancy plans, then discuss the type and duration of medication with your doctor.