Compounded Melasma Treatment

Melasma — chronic, hormone-driven, sun-aggravated pigmentation

Melasma is a chronic disorder of skin pigmentation characterised by patchy brown to grey-brown marks on the cheeks, forehead, upper lip, and chin. It disproportionately affects women, people with darker skin types (Fitzpatrick III–V — common in Malaysia), and is strongly driven by hormones (pregnancy, oral contraceptives, HRT) and UV exposure.

Melasma is treatable but rarely permanently cured. Most patients need long-term maintenance therapy plus rigorous sun protection.

Standard treatment ladder

1. Sun protection — broad-spectrum SPF 50+ with iron oxides (to block visible-light contribution to melasma), reapplied every 2 hours when outside.
2. Topical first-line:

• Modified Kligman formula (hydroquinone + tretinoin + low-dose hydrocortisone).
• Tranexamic acid topical 5%.
• Azelaic acid 15–20%.

1. Topical second-line / alternatives:

• Cysteamine 5% cream — for hydroquinone-resistant melasma.
• Topical methimazole — research-stage but used by some specialists.

1. Office-based: chemical peels (glycolic, mandelic, salicylic), pico/Q-switched laser (selective use — risk of post-inflammatory hyperpigmentation in dark skin types).
2. Oral: tranexamic acid (specialist supervision — clotting-risk screening required).

Common Lynnity melasma compounds

Compound	Composition (typical)	Use
Modified Kligman	Hydroquinone 4% + tretinoin 0.05% + hydrocortisone 1%	Night-time, 8–12 weeks, then taper
Hydroquinone-only	Hydroquinone 4% in non-irritant base	When tretinoin not tolerated
Tranexamic acid 5%	Topical cream	Add to morning routine, ongoing
Cysteamine 5%	Cream — 15-min daily wash-off	Hydroquinone-resistant cases
Azelaic acid 15–20%	Cream or gel	First-line in pregnancy / breastfeeding
Combination “cocktail”	Hydroquinone 2% + tranexamic acid 3% + niacinamide 4% + kojic acid 2%	Multi-mechanism maintenance

Important safety notes

• Hydroquinone can cause exogenous ochronosis (paradoxical darkening) if used continuously for years at high concentration. Standard protocol: 8–12 weeks on, 4 weeks off, with alternation against non-hydroquinone agents like tranexamic acid or azelaic acid.
• Tretinoin is teratogenic. Do not use during pregnancy. Discontinue before planned conception.
• Steroid-containing compounds (the hydrocortisone in modified Kligman) should not be applied continuously beyond 12 weeks due to skin-thinning risk.
• Sun protection is non-negotiable. Without daily SPF, no topical melasma compound will work.

How to start

See a dermatologist. Bring photos of the affected area for baseline. If they prescribe a compounded formulation, send the prescription to Lynnity.

See also: Dermatology service page.

FAQ

Does melasma ever go away permanently?

Sometimes — especially when the trigger is removable (e.g., stopping the oral contraceptive, post-pregnancy). Most cases recur without ongoing maintenance and strict sun protection. Treat it as a chronic condition.

Can I use modified Kligman during pregnancy?

No. Tretinoin and hydroquinone are both contraindicated in pregnancy. Azelaic acid is generally considered safe. Discuss with your dermatologist.

How long until I see results?

Modified Kligman typically shows visible lightening at 8–12 weeks. Tranexamic acid topical needs 8–16 weeks. Cysteamine usually shows results in 12–16 weeks.

Why does my melasma come back every time I go to the beach?

Even small UV exposure reactivates melanocytes in melasma-prone skin. You need broad-spectrum SPF 50+ with iron oxides (for visible-light coverage), reapplied every 2 hours, plus physical sun avoidance during peak hours. Without this, no topical therapy will hold.

Can lasers cure melasma?

Lasers are useful for some cases — especially picosecond Q-switched 1064 nm — but in dark-skin Malaysian patients there is real risk of post-inflammatory hyperpigmentation that worsens the appearance. Most dermatologists treat with topicals first, lasers second, very cautiously.