Hello
Since your melasma has been present for more than 6 months, is extensive, and continues to worsen despite daily sunscreen use and over-the-counter creams, a dermatologist evaluation is recommended. Melasma is often chronic and usually requires prescription treatment in addition to sun protection.
A typical daily routine includes a gentle cleanser, broad-spectrum SPF 50+ sunscreen every morning (reapplied every 2–3 hours when outdoors), and protective measures such as hats and avoiding excessive sun and heat exposure. At night, prescription depigmenting agents may be used. Common options include hydroquinone, tretinoin, azelaic acid, kojic acid, or combination creams containing hydroquinone, tretinoin, and a mild corticosteroid, depending on your skin type and medical history.
For severe or resistant melasma, dermatologists may consider oral tranexamic acid, chemical peels, microneedling, or carefully selected laser treatments. These treatments can be effective but require proper assessment because some procedures may worsen pigmentation in certain skin types.
Avoid using multiple fairness creams, steroid-containing creams without supervision, or harsh scrubs, as these can irritate the skin and make pigmentation worse. Improvement is usually gradual and may take several months, even with appropriate treatment.
A consultation with a dermatologist is important to confirm the diagnosis and create a personalized treatment plan, especially since your pigmentation is progressing despite consistent sunscreen use.
Regards Take care
Hello, thank you for sharing your concern. Melasma can be a very frustrating condition because it is often chronic and tends to recur, even after treatment. If your pigmentation has been present for more than 2 years and has continued to worsen despite multiple prescribed creams, it would be important to reassess both the diagnosis and treatment strategy.
Possible reasons for worsening include: • Continued sun exposure (even through windows or during short outdoor periods) • Heat exposure (which can worsen melasma even when sunscreen is used) • Hormonal factors • Skin irritation from using multiple active products • Incorrect diagnosis (some other pigmentation disorders can resemble melasma)
A few important points: • Using many different creams over time can sometimes irritate the skin and worsen pigmentation (post-inflammatory hyperpigmentation) • Sunscreen should ideally be broad-spectrum SPF 50+ and reapplied every 2–3 hours when outdoors • Physical protection (hat, umbrella, shade) is often as important as sunscreen • Avoid harsh scrubs, excessive exfoliation, and frequent product changes
If standard creams have not helped, a Dermatologist may consider: • Triple-combination depigmenting creams (under supervision) • Azelaic acid • Tranexamic acid (only after medical assessment) • Chemical peels • Laser/light-based treatments in selected patients
Since your pigmentation is worsening despite treatment, I would strongly recommend a review by a Dermatologist rather than continuing to add more over-the-counter products.
Please seek re-evaluation sooner if: • Pigmentation is spreading rapidly • The color or appearance is changing significantly • There is associated redness, itching, scaling, or irritation
Prescription: 1. Continue broad-spectrum sunscreen SPF 50+ daily and reapply when outdoors 2. Avoid excessive heat exposure and direct sunlight 3. Use a gentle cleanser and moisturizer; avoid harsh scrubs and frequent product changes 4. Do not start multiple new depigmenting creams without supervision 5. Dermatologist consultation advised for reassessment of diagnosis and consideration of advanced treatment options
Dr. Nirav Jain MBBS, D.Fam.Medicine
Hello dear Melasma is due to Suj exposure Pigmentation due to hormonal alterations Dust exposure Please do not worry and follow instructions below. Usually the appearance ranges from red inflammatory to comedonal white heads.
Medications: 1. Topical Treatments -Benzoyl Peroxide (2.5–5%) twice a day for week Salicylic Acid, Adapalene 0.1% can also be given as additive medications. 2.Clindamycin 1% Clindac A ,Tretinoin ( if already not taken). 3.Azelaic Acid 10 percent for two weeks. 4. Oral Medications -tablet Doxycycline 1 month twice a day for max 5 days or Tab Minocycline ( take precautions to avoid in pregnancy) 5.Oral contraceptives - Diane-35 with addition of Spironolactone on recommendation only by gynacologist in person only
Supportive medications Niacinamide serum –antiinflammatory in nature twice daily for 1 week In addition use aloevera - tulsi solution to apply topically for 1 month
In case of no improvement in 1 month, kindly consult dermatologist in person for better clarification There may be requirement of Laser Photdynamic therapy Electro cautery Regards
