Monotherapy VS Combination Therapy for Melasma and Dark Spots on Face

Melasma, also known as the mask of pregnancy, is an area of hyperpigmentation usually found in the face. The condition tends to affect primarily women aged 20 to 30 years old and is commonly found in women with darker skin types. While melasma is considered a cosmetic condition, many patients with melasma experience considerable stress and embarrassment related to the condition, which is exacerbated by the lack of effective and lasting treatments.

What causes melasma?

The exact causes of melasma aren’t yet fully understood, but there are a number of factors that can influence the appearance of melasma. Exposure to UV appears to trigger outbreaks of melasma in predisposed individuals. There also seems to be a genetic component. The use of oral contraceptives also appears to be a trigger as well. What is discouraging to many women is that while they may successfully treat an outbreak of melasma, there is a high likelihood of another outbreak in the future.

How is melasma treated?

There are many therapies and approaches to deal with melasma. Topical creams that contain depigmentation agents such as corticosteroids, hydroquinone or tretinoin have been shown to be relatively effective at treating melasma by removing the darker skin cells. Some creams use three of the depigmentation agents at once, and this type of combination therapy appears to offer the best results. Unfortunately, topical creams may take months to take effect, and there are a number of side effects associated with prolonged use of these creams, including redness and irritation.

There are also therapies that involve taking a pill to halt the production of melanin in the skin. These oral therapies can take up to six months to work as they rely on the skin layer regenerating itself without the hyperpigmentation. Unfortunately, oral treatments for melasma have quite severe side effects ranging from headaches and tinnitus to abdominal bloating and menstrual irregularities.

There has been a lot of interest recently about using chemical skin peels to remove the offending melasma layer. These peels are especially effective when the melasma only affects the top layer of the skin, the epidermis, but are less effective if the melasma also affects the underlying skin layer. Laser treatments that specifically target melanin are also being explored as a potential therapy for melasma, but these therapies have shown little effect in treating severe melasma cases.

Monotherapy vs. combination therapy

While certain topical creams and other procedures can be used to treat melasma on their own, it appears that the most effective way to treat the condition is to combine a number of treatments together. For instance, a topical cream containing a combination of depigmentation agents usually works better than products that contain only one agent. Other therapies, such as oral treatments or chemical peels have also shown to be more effective when used in conjunction with topical creams. As melasma is a condition that has a number of triggers, it makes sense that a combination of therapies would be more effective in reducing the appearance and recurrence of melasma. Many therapists will also recommend additional safeguarding steps, such as the use of sunscreen and widebrim hats to reduce the reappearance after the condition has been treated to prevent recurrent outbreaks.


Melasma is a condition that is frustrating to treat due to the prolonged treatment time and the possibility of subsequent outbreaks. Despite this, advances are continuously being made, and a combination of various therapies will be effective in treating melasma in most patients.


Ogbechie-Godec, O. A., & Elbuluk, N. (2017). Melasma: An Up-to-Date Comprehensive Review. Dermatology and Therapy, 7(3), 305-318. doi:10.1007/s13555-017-0194-1

Rivas, S., & Pandya, A. G. (2013). Treatment of Melasma with Topical Agents, Peels and Lasers: An Evidence-Based Review. American Journal of Clinical Dermatology, 14(5), 359-376. doi:10.1007/s40257-013-0038-4

Souza, L. F., & Souza, S. T. (2012). Single-session intense pulsed light combined with stable fixed-dose triple combination topical therapy for the treatment of refractory melasma. Dermatologic Therapy, 25(5), 477-480. doi:10.1111/j.1529-8019.2012.01530.x

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