This is my Melasma algorithm: Hydroquinone triple cream qhs x 6 months + azelaic acid in the AM + tinted sunscreen Consider PO TXA (half of 650 mg tab bid), polypodium leucotomos bid (heliocare) Maintenance: stop hydroquinone and switch to compounded TXA/kojic/tretinoin combo cream qhs + vitami...

Depends on the reason one is not responding. For example, one of our approaches for treating patients that are not responding to hydroquinone is a product called Cyspera. This cream helps to decrease melanin pigment within the skin without the use of HQ or Retinol. Easy to apply, leave on uncleaned ...