A 27-year-old woman in her second trimester of pregnancy has progressive malar melasma. Her dermatologist wishes to start a topical hypopigmenting agent that is considered safe during pregnancy. Which agent should be chosen?

• A Kligman's triple combination cream
• B Tretinoin 0.05% cream
• C Hydroquinone 4% cream
• D Azelaic acid 20% cream ✓

Explanation

Azelaic acid is a dicarboxylic acid that competitively inhibits tyrosinase, is minimally absorbed systemically, and is regarded as safe in pregnancy, making it the preferred agent for melasma during gestation. Tretinoin is teratogenic and absolutely avoided in pregnancy. Hydroquinone has significant systemic absorption and possible mutagenicity concerns, so it and any triple combination containing it plus tretinoin are deferred until after delivery and lactation.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.