We put the patient on a 2 month topical regimen including topical retinoid, hydroquinone 6% with other botanical brightening agents, fluocinolone mild steroid, and a daily sunscreen with >10% zinc oxide. In addition, the patient reapplied zinc based sunscreen powder every 2 hours (even if indoors) daily. Every 2 weeks we performed a salicylic acid peel 30% and started the patient on oral tranxenemic acid. In just 2 months she had 80% improvement. The after photo the patient is not wearing makeup, just tinted sunscreen powder.
(May 16, 2018)