Clinical reference

Melasma (Chloasma)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

BAD Guidelines for Management of Hyperpigmentation 2021 · DailyMed Hydroquinone 4% Cream Package Insert, SetID 8f3bf0d0-40e1-4560-a2ea-9e7978cece4d · UK eMC Skinoren 20% Cream SmPC (Bayer plc), product id 1423

Verified against3 documents

DailyMed Hydroquinone 4% Cream Package Insert, SetID 8f3bf0d0-40e1-4560-a2ea-9e7978cece4d
UK eMC Skinoren 20% Cream SmPC (Bayer plc), product id 1423
Melasma (Chloasma) - disease-level clinical article (melasma-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

Gradual onset with flare-ups during periods of more sun or visible-light exposure is typical
Melasma commonly starts or worsens during pregnancy or with oral contraceptives or hormone therapy

Signs — what you find (3)

Symmetric, irregularly bordered, evenly colored brown patches appear on the face, most often in a centrofacial pattern [pigmentation change]
The patches are not scaly or raised and cause no symptoms, unlike inflammatory skin conditions that can look similar
Extrafacial melasma on the forearms or neck is more common after menopause

Tests (4)

Melasma is a clinical diagnosis, and routine lab testing is not needed in typical cases
Wood lamp findings are unreliable, especially in darker skin, and should not guide treatment decisions
Dermoscopy can show a brown network pigment pattern, sparing around hair follicles, and visible small vessels
Hormone-related blood tests are not routinely needed unless the presentation is atypical

If not this — what else fits (4)

Exogenous ochronosis causes paradoxical blue-black pigmentation after long-term hydroquinone use and resists treatment
Post-inflammatory hyperpigmentation typically follows a prior inflammatory skin condition, unlike melasma
Lichen planus pigmentosus, including facial forms, can mimic melasma's facial pigmentation
Drug-induced hyperpigmentation and pigmented contact dermatitis are also on the differential

SourceStatPearls "Melasma" - disease-level clinical article

Presentation findings are traced to the source above.

HYDROQUINONE

1st line

Formtopical

Adult dose and duration

Apply Hydroquinone 4% Cream to affected areas twice daily, in the morning and before bedtime

Paediatric dose

Safety and efficacy in pediatric patients have not been established

Dose source

DailyMed Hydroquinone 4% Cream Package Insert, SetID 8f3bf0d0-40e1-4560-a2ea-9e7978cece4d

Why

Inhibits tyrosinase, the rate-limiting enzyme in melanin synthesis, lightening the hyperpigmented patches of melasma; first-line topical agent.

Cautions

There is a risk of post-inflammatory hyperpigmentation or exogenous ochronosis with prolonged use.
Strict daily broad-spectrum photoprotection (SPF 15 or greater) is mandatory.
Discontinue if no improvement is seen after 2 months of treatment.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CLEARALIQUE FORTE 4% CREAM 30 GM	DELTA PHARMA	8.00 EGP
MELOQUIN 4% CREAM 20 GM	BIOPHARM EGYPT > SAJA PHARMA	60.00 EGP
CLEARALIQUE 2% CREAM 30 GM	DELTA PHARMA	6.00 EGP

AZELAIC ACID

2nd line

Formtopical

Adult dose and duration

Apply 15% gel or 20% cream twice daily (morning and evening) to affected areas after washing x up to 6 months

Paediatric dose

Safety and efficacy in children under 12 years have not been established for melasma/hyperpigmentation

Dose source

UK eMC Skinoren 20% Cream SmPC (Bayer plc), product id 1423

Why

Also inhibits tyrosinase to reduce melanin production, used as the alternative to hydroquinone in patients who cannot tolerate it, including during pregnancy and lactation.

Cautions

Inhibits tyrosinase; safe alternative in hydroquinone-intolerant patients.
Transient local burning or stinging is common during the initial weeks.
Not an unqualified safe-in-pregnancy drug. The Skinoren 20% Cream SmPC says at 4.6, verbatim: "Caution should be exercised when prescribing azelaic acid to pregnant women." For lactation: "Infants must not come into contact with treated skin/breast." It remains the usual choice for melasma arising in pregnancy, where the alternatives are worse, but the label does not call it safe.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AZECLEAR 20% CREAM 30 GM	BIOPHARM EGYPT > SAJA PHARMA	21.60 EGP
EZALIC 20% CREAM 30 GM	MULTI-APEX	26.40 EGP
SKINOREN 20% CREAM 30 GM	INTENDIS MANUFACTURING SPA-ITALY > BAYER HEALTHCARE	35.50 EGP
AZADERM 20% CREAM 30 GM	MUP	87.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.