Melasma treated with hydroquinone, tretinoin, and a fluorinated steroid

A retrospective study was conducted in six Hispanic women, 35-55 years of age, with Fitzpatrick skin types IV to VI, presenting to an academic dermatology clinic for resistant melasma (Table 1). They had all been treated with topical hydroquinone (2-4%) without success prior to being seen in our clinic. A Wood's lamp was used to determine whether the melasma was epidermal, dermal, or a combination of the two. The patients were treated with a mixture containing 0.05% tretinoin cream, 0.05% triamcinolone acetonide cream, 6% hydroquinone, and 0.1% ascorbic acid (as a preservative) applied at night, and a sun protection factor (SPF) 15 UVB-blocking sunscreen was applied each morning. They were instructed to use the mixture on the affected areas nightly for a period of 8 weeks. All of the patients were evaluated at baseline and monthly during the treatment period. Improvement in pigmentation was assessed at each subsequent visit by clinical examination and photography with polarized filters as well as black and white UV reflectance photography (Canfield Scientific, Inc.). Improvement was determined subjectively on a three-point scale as follows: I, mild improvement; II, moderate improvement; III, significant improvement.