Can vitamin b3 niacinamide or azelaic acid used together?

Thank you for your question.  I would suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.  

There are common precipitors for melasma that include hormones (estrogen and progesterone), birth control pills, stress, thyroid problems, sun exposure, and inflammation. In my practice, I use a combination of topicals: 
Melarase AM and Melarase PMMelapadsMelaclenzReplenish Retinoid CreamOnce started, we combine this regimen with fractional laser, pulsed dye laser, Covalent chemical peels, and LED Yag. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Yes, a B3 can help with free radicals. Combination treatments are best for melasma. 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