Melasma — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

EasyInflammatory DermatosesMelasmaSCE Dermatology

A 40-year-old woman has facial melasma. She has symmetrical brown patches on her cheeks, forehead, and upper lip. She is on the combined oral contraceptive. What is the most important initial management step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Sun protection (broad-spectrum SPF 50+) and consideration of stopping the combined oral contraceptive if possible

Melasma management starts with addressing modifiable triggers: rigorous broad-spectrum sunscreen (SPF 50+ with high UVA protection — melasma is predominantly UVA-driven), sun avoidance, and consideration of stopping hormonal triggers (combined OCP, HRT). First-line topical treatment is a combination of Hydroquinone (2-4%) + topical retinoid (Tretinoin) + topical corticosteroid (triple combination/Kligman formula) for 2-3 months. Azelaic acid 20% and Vitamin C serum are alternatives. Chemical peels (glycolic acid) and certain lasers (low-fluence Q-switched Nd:YAG) are second-line. Melasma is chronic and relapsing — maintenance sunscreen and topical treatment are essential.

Reference: BAD 2019 Patient Information; BJD Melasma Review