A 35-year-old woman with symmetrical hyperpigmentation of the upper lip, cheeks, and forehead is treated with triple combination cream. Which three agents constitute the most commonly used triple combination for melasma?

• A Azelaic acid + kojic acid + sunscreen
• B Hydroquinone + tretinoin + mometasone furoate ✓
• C Hydroquinone + tretinoin + betamethasone valerate
• D Arbutin + niacinamide + tranexamic acid

Explanation

The Kligman formula (modified triple combination) consists of hydroquinone 4%, tretinoin 0.05%, and a mid-potency fluorinated corticosteroid (mometasone furoate or fluocinolone acetonide). Hydroquinone inhibits tyrosinase to block melanin synthesis, tretinoin enhances epidermal turnover and penetration of hydroquinone, and the corticosteroid reduces irritation and has its own anti-melanogenic effect. This combination is the most widely studied and effective treatment for epidermal melasma but should not be used for prolonged periods to avoid steroid side effects.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.