How I manage resistant melasma?

Melasma is a cosmetic disorder with profound psychological impact. Multiple therapies are available for melasma but no therapy is the gold standard. The most of the patients suffer from relapses and recurrences which force the patient to opt for over-the-counter medications containing topical steroids or indigenous medications. Use of these has led to the emergence of complicated cases of melasma which are refractory to the treatment. Along with hyperpigmentation, such patients also have steroid-induced side effects such as rosacea, atrophy of skin, and telangiectasia. Many patients develop exogenous ochronosis due to prolonged use of hydroquinone-based therapies. The present article focuses on the management of these cases of melasma.