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Try a triple combination cream containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% as first-line therapy for patients with melasma. The cream is applied twice a day for 8 to 24 weeks and up to 12 months. With refractory melasma, chemical peels or laser and light-based therapies may be used in conjunction with skin lightening agents. However, these treatments should be used with extreme caution in patients with darker skin types who have an increased risk of postinflammatory hyperpigmentation.