Doctor performing treatment for<unk>  with potassium titanyl phosphate laser Assessment by a dermatologist can help guide treatment. Treatments to hasten the fading of the discolored patches include: * Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (OTC - 2%) or prescription (4%) strength. HQ inhibits tyrosinase, an enzyme involved in the production of melanin. * Tretinoin, a retinoid, increases skin cell (keratinocyte) turnover. This treatment is not used during pregnancy due to risk of harm to the fetus. * Azelaic acid (20%) is thought to decrease the activity of melanocytes. * Tranexamic acid by mouth has shown to provide rapid and sustained lightening in<unk>  by decreasing melanogenesis in epidermal melanocytes. * Cysteamine hydrochloride (5%) over-the-counter Mechanism of action seems to involve inhibition of melanin synthesis pathway *Kojic acid (2%) OTC * Flutamide (1%) * Chemical peels * Microdermabrasion to dermabrasion (light to deep) * Galvanic or ultrasound facials with a combination of a topical crème/gel, either in an aesthetician's office or as a home massager unit * Laser but not intense pulsed light (which can make the<unk>  darker) Effectiveness Evidence-based reviews found that the most effective therapy for<unk>  includes a combination of topical agents. Triple combination creams formulated with hydroquinone, tretinoin, and a steroid component have shown to be more effective than dual combination therapy or hydroquinone alone. More recently, a systematic review found that oral medications also have a role in<unk>  treatment, and have been shown to be efficacious with a minimal number and severity of adverse events. Oral medications and dietary supplements employed in the treatment of<unk>  include tranexamic acid, Polypodium leucotomos extract, beta‐carotenoid, melatonin, and procyanidin. Oral procyanidin combined with vitamins A, C, and E shows promise as safe and effective for epidermal<unk> . In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated. In all of these treatments, the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide, is preferred, because UV-A, UV-B, and visible lights are all capable of stimulating pigment production. Many negative side effects can go along with these treatments, and treatments often are unsatisfying overall. Scarring, irritation, lighter patches of skin, and contact dermatitis are all commonly seen. Patients should avoid other precipitants, including hormonal triggers. Cosmetic camouflage can also be used to hide<unk> . <!--
Melasma
Tar melanosis
Xanthelasma
Ichthyosis
Pomade acne
Feline acne
Melanosis
Erythrasma