Melasma is known to get worse over the years, how to manage it so that mine can stay in control?

There is no cure for melasma and some patients have worsening melasma despite everything tried.  The most important thing is to keep inflammation low, stay in lightening creams, do the appropriate laser treatments and sun protection/heliocare.  Best, Dr. Emer.

Thank you for your question.  Skin discoloration is a very prevalent problem in women over the age of twenty.  It is also increasingly common in men with increased sun exposure.  
Risk factors include thyroid disease, sun exposure, hormones, pregnancy, family history, PIH, and birth control. Melarase AM and Melarase PM have been extremely effective in reducing pigmentation associated with skin discoloration and hyperstimulation of melanocytes. 
In my practice, patients with hyperpigmentation benefit from twice daily application of the creams. Melarase AM in the morning, followed by Melarase PM in the evening. Melarase AM contains four active sunblocks, so sunscreen is not needed unless your sun exposure is very high or you had a recent procedure/laser. SPF of 30. Melarase PM contains active skin lighteners to even out skin pigmentation. If you are concerned about the development of pigmentation, contact our office to discuss details and to obtain a regimen for Melarase. 
Recommendations:  5-step Daily Brightening Kit has everything you need to improve dark spots, skin discoloration, melasma, and hyperpigmentation caused by sun exposure, hormones, scarring, and the environment. It’s a powerful daily brightening kit that can help bring out your skin’s natural, healthy glow. Ideal for use on the face, neck, and hands. 
Includes: Melaclenz, Melapads, Melarase AM, Melarase PM, Elevase, and Spectrase
Best, 
Dr. Karamanoukian
Los Angeles

Measma is persistent in certain women especially of Mediterranean descent. Either a vi peel or lasers can lighten the area but additional treatment may be necessary later because of the persistent nature of the problem. 

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.

All the best,

Dr Davin Lim

Laser, surgical and aesthetic
dermatologist

Brisbane, Australia