Hydroquinone is widely considered the gold standard and first-line topical treatment for melasma. It acts by inhibiting tyrosinase, an enzyme crucial for melanin synthesis, and also by causing selective damage to melanocytes. While tretinoin and azelaic acid are also used in melasma treatment (often in combination with hydroquinone), and corticosteroids can be part of triple therapy, hydroquinone alone or as the primary depigmenting agent is the cornerstone of therapy. Topical corticosteroids alone are not a first-line treatment for melasma due to potential side effects and lack of direct depigmenting action.
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