Tough melasma. Can I use Lytera 2.0 and Hydroquinone to treat it? (Photo)

Melasma needs a combination approach to get the best improvement and will need a series of treatments. First and foremost, always wear sunscreen daily. Cosmelan is a “gold standard” leave-on peel that has a high concentration of antioxidants and skin brightening actives that can used safely on all skin types especially skin types that have irregular pigmentation such as African American, hispanic, asian and mixed ethnicities. Its effects are to improve discoloration, hyperpigmentation, melasma, while also helping skin texture, pores, and acne scarring. Cosmelan inhibits tyrosinase, an enzyme in the melanin formation process, the process of your skin tanning. So the end result is a more even skin tone without as many irregularities. Other treatments in our practice, we combine Clear + Brilliant, peels, Microneedling/PRP, Aerolase, and sometimes Erbium Laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Melasma and age spots can be due to hormones, aging, sun exposure, thyroid dysfunction, and genetics. Treatments range from IPL to laser therapy; but pigmentation may recur if not complemented with topical creams to stabilize the pigment cells. 
I would suggest starting with Melarase Brightening Kit with Melaclenz, Melapads, Melarase AM, and Melarase PM to help stabilize pigmentation and reduce recurrence. Once started, an active protocol that includes Covalent peels, IPL, fractional laser, and microneedling can further remove pigmentation.
Best, Dr. KaramanoukianRealself100 Surgeon

Thank you for your question.  I would start applying a thin layer of hydroquinone morning and night two weeks prior to a laser treatment.  Do not treat melasma with IPL that could make it worse.  An effective treatment for melasma is the fractional non ablative laser.  The downtime is 24-48 hours and the treatment help to make the discoloration dissipate.  

the Picosure laser is the best treatment for melasma. It fires 1,000 times faster than any other laser. You should plan at least 3 treatments, spread each a month apart. there is little to no downtime with the picosure laser. You need to use an excellent sunblock that you frequently reapply. If you have ethnic skin, then you should pre-treat with HQ for 2-3 weeks before your first picosure laser treatment. you should then continue Lytera and/or HQ for several months. david berman md

Yes, you can use both HQ and Lytera - this is ideal as we always try to limit the use of HQ. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia