{ "schema_version": 1, "kind": "condition", "id": "melasma", "name": "Melasma (Chloasma)", "category": "chronic", "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", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1178, "generic": "Hydroquinone", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply Hydroquinone 4% Cream to affected areas twice daily, in the morning and before bedtime", "adult_duration": null, "dose_source": "DailyMed Hydroquinone 4% Cream Package Insert, SetID 8f3bf0d0-40e1-4560-a2ea-9e7978cece4d", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in pediatric patients have not been established", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CLEARALIQUE FORTE 4% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELOQUIN 4% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLEARALIQUE 2% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "melasma" }, { "id": 1177, "generic": "Azelaic acid", "line": 2, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "Apply 15% gel or 20% cream twice daily (morning and evening) to affected areas after washing", "adult_duration": "up to 6 months", "dose_source": "UK eMC Skinoren 20% Cream SmPC (Bayer plc), product id 1423", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in children under 12 years have not been established for melasma/hyperpigmentation", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AZECLEAR 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOPHARM EGYPT > SAJA PHARMA", "price_egp": 21.6, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EZALIC 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 26.4, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SKINOREN 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTENDIS MANUFACTURING SPA-ITALY > BAYER HEALTHCARE", "price_egp": 35.5, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AZADERM 20% CREAM 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 87.0, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "melasma" } ] }