I saw my dermatologist on April 29th 2016 for melasma. He wants me to try HQRA What are your thoughts

Dark pigmentation on the skin can be due to melasma, age spots, and sun damage. Melasma is a specific hormonally-influenced skin condition in which pigmentation is deposited by overactive pigment cells in your skin.

In our office, we individualize treatments for melasma and skin discoloration based on skin type, skin complexion, hormonal influences, and ethnicity.

Treatments for melasma begin with Melarase creams as follows:

MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Additional therapies include fractional laser, fractional RF, Covalent peels, and LED microneedling with Replenish serum. The video demonstrates the clear and brilliant laser that is used alongside Melarase creams.

Best, 

Dr. Karamanoukian

Realself100 Surgeon

Thanks for your question.  Melasma can be due to hormones, so one thing to consider is whether or not you are using a hormonal birth control.  Sometimes birth control pills can make the melasma worse, so discuss that with your gynecologist.  Sun protection is also vitally important to prevent the melasma from worsening, so a zinc-containing sunscreen such as the Elta MD products are great ones to try.  Retin-a (tretinoin) and hydroquinone are both useful ingredients to help combat the pigment issue, but you are right, some people get dry and peeling skin with the retin-a.   Backing off with the frequency of use will be fine, and use a good moisturizer like Avene Tolerance Cream or Emulsion.
Best of luck!

If the 7% concentration is too strong, dilute with an Opti-Ceramide cream (1:1) and use it at approximately 3.5% to 4% strength.Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. 
Daily good habits with topicals may well help you chieve your goals with a good skin system like the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link). 
Melarase AM is non hydroquinone based. 
Clear + Brilliant laser can be added once you start your pretreatment with topicals. 
Best
H Karamanoukian MD FACS

The concentrations given by your dermatologists are safe to use for cases of melasma as it is one of the most difficult conditions to treat .However if your are having an uncomfortable experience i suggest you can decrease the quantity of the products being used . For  example start with the pea sized about of retino A and use a base brightening cream containing arbutin/ kojic to mix the HQ with.This combination shoukd be used at night only .use a moisturiser/Aquaphor in the morning to combat the redness and dryness and reapply a braod spectrum sunscreen every 3 hours .you can increase the amount of retino and HQ being used once your skin gets adapted to products Hope this helps 

Great! That is the starting point for most of my melasma patents. If peeling, use less, use less often!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.

In some cases I combine glycolic
AHA peels, and in other cases I use a tablet called Tranexamic acid to help.

More information on available
treatments in the Web Reference below.

All the best,

Dr Davin Lim

Laser, surgical and aesthetic
dermatologist

Brisbane, Australia