For Melasma, why does hydroquinone such as obagi or tri-luma work for some women and not others?

I have tried pigmanorm and a strong HQ cream( 10%) with no success. whereas, I read reviews of women who completely got rid of their melasma with some HQ product. why is it that HQ works for some people and not others?

Doctor Answers 6

HQ and non hydroquinone based topicals for melasma

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Every patient has a different response to specific product types and formulations.

Some skin types are less prone to respond to topical treatment than others. 

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 and allowed for use in the EU and UK.

Clear + Brilliant laser can be added once you start your pretreatment with topicals. 


H Karamanoukian MD FACS

Some cases not responsive to HQ.

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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. If you have tried 10% HQ along with the methods outlined below, and your pigmentation has not shifted, you probably have marked dermal melsama or ochronoisis from long term HQ use. I suggest you see a dermatologist for evaluation. 

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 

Melasma Treatment

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Melasma can manifest superficially in the skin and this is where creams such as Tri-Luma or systems such as Obagi Nuderm are most effective. Melasma slightly deeper in the skin responds to Chemical Peels, Fraxel Laser, or Pico Lasers. There are Melasma subtypes that are very resistant to treatment. Always be sure to protect your skin with sun exposure and discuss all triggers and a stepwise approach to treatment with your dermatologist.

Anita Saluja, MD
Melbourne Dermatologist
5.0 out of 5 stars 24 reviews

Melasma treatment with Melarase PM

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Some melasma has a hormonal basis so until you correct that problem, there is no longterm solution for melasma. 


Dr. Karamanoukian

Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Melasma and Treatment

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Not all cases of Melasma are the same.  Some require more aggressive treatment then hydroquinones, especially if they were made worse by laser treatments such as through IPL or Fraxel.  Cosmelan or chemical peels may be needed.  Please consult a specialist in melasma.  Best, Dr. Green

Melasma and Sun Spots -- Best Treatment Is Clear + Brilliant / Aerolase w Microneedling PRP, Pro Yellow is Useful

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Melasma can be treated, but not cured. Every patient responds differently. Please see an expert to find what's best for you. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.