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Background: Melasma is an acquired hypermelanosis that is often recalcitrant to treatment with hypopigmenting agents.Objective: To assess the efficacy of 4% hydroquinone cream vs 4% hydroquinone cream combined with glycolic acid peels as treatment for melasma.Methods: Twenty-one Hispanic women with bilateral epidermal and mixed melasma were enrolled in a splitfaced prospective trial lasting 8 weeks. Patients underwent 20% to 30% glycolic acid peels every 2 weeks to one side of the face only in addition to twice-daily fullface application of 4% hydroquinone cream and sun protective factor 25 UV-B sunscreen each morning. Pigmentation was measured objectively using a mexameter and the Melasma Area and Severity Index and subjectively using a linear analog scale and physician and patient global evaluation.Results: Hydroquinone treatment alone and treatment with the combination of hydroquinone and glycolic acid had a significant effect in reducing skin pigmentation compared with baseline (PϽ.001). However, no significant difference was found using combination therapy compared with hydroquinone alone (P =.75).Conclusions: Use of 4% hydroquinone and a daily sunscreen is effective in the treatment of melasma; however, the addition of 4 glycolic acid peels did not enhance the hypopigmenting effect of hydroquinone treatment alone.

A cream containing 4% hydroquinone, 10% buffered glycolic acid, vitamins C and E, and sunscreen is safe and effective in the treatment of melasma.

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. Patient demographics Patient Age Country 
 of origin Affected 
 area Duration of 
 disease (years) Severity Type of 
 melasma 139El SalvadorCheeks,
upper lip10ModerateEpidermal237MexicoCheeks12ModerateEpidermal335MexicoCheeks7ModerateCombination435MexicoCheeks9ModerateEpidermal555MexicoCheeks, jaw20ModerateCombination632MexicoCheeks, forehead6ModerateEpidermal 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.