Depigmenting agents and therapies are essential for the treatment of melasma. Most dermatologists use two de-pigmenting agent categories, phenolic agents or natural agents. Hydroquinone, which is available as a over-the-counter bleaching agent and in prescription products, is most commonly used. However, now the Food and Drug Administration (FDA) has issued a warning about this product as they are concerned about its carcinogenic properties. As such, dermatologists might soon have to turn to other agents or the natural de-pigmenting agents in their treatment procedure. Physicians can also turn to natural agents, which do not have any side effects, though these take time to show results.

Alternatives to Hydroquinone
a. Monobenzyl ether of hydroquinone, a phenolic agent which is the permanent de-pigmenting agent, generally used to treat patients with severe vitiligo.
b. Mequinol, another phenol, is also an alternative. This is used in Europe.
c. Tretinoin, a hydroxyanisole, can also be used. It speeds up the effects of depigmenting agents.
d. Azelaic acid, a naturally occurring hydroxyl carboxylic acid (not a phenol), can also be used.
e. Lemon juice, grapefruit juice, papaya or kiwi juice are other options of natural depigmenting agents.
f. Licorice (topical glabridin), Kojic acid and Arbutin are other options.
g. If the patient asks for quick results, then chemical peels are the best option.
h. Intense-pulsed light (IPL) can also be used.