Ducray Melascreen UV Rich Cream SPF 50+ 40ml tube
Full protection for Hyperpigmentation
What Makes This Different

Most 'pigmentation sunscreens' just slap a high SPF number on a generic base. Melascreen Rich uses a four-filter photostable system specifically chosen for deep UVA coverage — the wavelengths that drive melasma — and layers in a melanogenesis-modulating peptide with ferulic acid. It's one of the few SPFs designed around the specific biology of pigmentation rather than general sun protection.

Ducray

Ducray Melascreen UV Rich Cream SPF 50+ Review

Melasma Specialist SPF
sunscreen cream pharmacy brand Paraben Free Not Cruelty Free

Ducray Melascreen UV Rich is one of the rare sunscreens built around the actual biology of melasma instead of a generic SPF number. The four-filter European system prioritizes deep UVA coverage, and the Nonapeptide-1 plus ferulic acid backup gives it real pigmentation credentials. At $32 for 40ml it's not cheap, but for anyone actively managing hyperpigmentation it earns the spend.

$32.00
40ml
4.4 ★★★★★
1,200 reviews
Made in France Launched 2018 All-year use PAO: 12 months
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Verdicts

How well it fits each concern

Verdict by concern tap a concern for the case

Full protectionfor HyperpigmentationBroad-spectrum SPF 50 with avobenzone, bemotrizinol (Tinosorb S), Uvinul A Plus, bisoctrizole (Tinosorb M): the protection hyperpigmentation calls for.Not yet assessedStandard tolerabilityNo reviews collected yet

The case for it

  1. Broad-Spectrum UV Filter System has no evidence row yet for this concern — it is in the research queue.
  2. The formula carries no trigger this concern is sensitive to, with the cautions noted.

What would change this: A researched evidence row for the lead active would replace this with a verdict.

Same rule for everyone. “Full protection” is the verdict on 2,288 of 45,024 concern verdicts across the catalog; rule P1 decided 2,232 of them. Unchanged since September 5, 2026, engine 5.1.1.

Brand or formulator? Disclose a concentration or correct a fact →

Show the work
Rule
P1 — Photoprotection standing is regulatory (M020 / Annex VI filters; 21 CFR 201.327 attaches the early-skin-aging claim to tested broad-spectrum SPF 15+). SPF 30 is the AAD daily-use bar. · the full register
Carrying active
Broad-Spectrum UV Filter System
Standing
not assessed
Form
plausible
Tolerability
standard
All hyperpigmentation products →
Basic protectionfor MelasmaBroad-spectrum SPF 50, but no iron oxides — melasma is worsened by visible light, which UV filters alone do not block.Not yet assessedStandard tolerabilityNo reviews collected yet

The case for it

  1. Broad-Spectrum UV Filter System has no evidence row yet for this concern — it is in the research queue.
  2. The formula carries no trigger this concern is sensitive to, with the cautions noted.

What would change this: A researched evidence row for the lead active would replace this with a verdict.

Same rule for everyone. “Basic protection” is the verdict on 175 of 45,024 concern verdicts across the catalog; rule P3 decided 68 of them. Unchanged since September 5, 2026, engine 5.1.1.

Brand or formulator? Disclose a concentration or correct a fact →

Show the work
Rule
P3 — Full UV protection without the visible-light layer melasma needs. · the full register
Carrying active
Broad-Spectrum UV Filter System
Standing
not assessed
Form
plausible
Tolerability
standard
All melasma products →
Full protectionfor Dark SpotsBroad-spectrum SPF 50 with avobenzone, bemotrizinol (Tinosorb S), Uvinul A Plus, bisoctrizole (Tinosorb M): the protection dark spots calls for.Not yet assessedStandard tolerabilityNo reviews collected yet

The case for it

  1. Broad-Spectrum UV Filter System has no evidence row yet for this concern — it is in the research queue.
  2. The formula carries no trigger this concern is sensitive to, with the cautions noted.

What would change this: A researched evidence row for the lead active would replace this with a verdict.

Same rule for everyone. “Full protection” is the verdict on 2,288 of 45,024 concern verdicts across the catalog; rule P1 decided 2,232 of them. Unchanged since September 5, 2026, engine 5.1.1.

Brand or formulator? Disclose a concentration or correct a fact →

Show the work
Rule
P1 — Photoprotection standing is regulatory (M020 / Annex VI filters; 21 CFR 201.327 attaches the early-skin-aging claim to tested broad-spectrum SPF 15+). SPF 30 is the AAD daily-use bar. · the full register
Carrying active
Broad-Spectrum UV Filter System
Standing
not assessed
Form
plausible
Tolerability
standard
All dark spots products →
Full protectionfor Sun DamageBroad-spectrum SPF 50 with avobenzone, bemotrizinol (Tinosorb S), Uvinul A Plus, bisoctrizole (Tinosorb M): the protection sun damage calls for.Moderate evidenceStandard tolerabilityNo reviews collected yet

The case for it

  1. Broad-Spectrum UV Filter System is a first-line active — approved, monograph-listed or named in current guidelines — for this concern.
  2. It is plausibly present at a working level, though the concentration is not declared.
  3. The formula carries no trigger this concern is sensitive to, with the cautions noted.

What would change this: A declared concentration would move this to a firmer reading of the dose.

Same rule for everyone. “Full protection” is the verdict on 2,288 of 45,024 concern verdicts across the catalog; rule P1 decided 2,232 of them. Unchanged since September 5, 2026, engine 5.1.1.

Brand or formulator? Disclose a concentration or correct a fact →

Show the work
Rule
P1 — Photoprotection standing is regulatory (M020 / Annex VI filters; 21 CFR 201.327 attaches the early-skin-aging claim to tested broad-spectrum SPF 15+). SPF 30 is the AAD daily-use bar. · the full register
Carrying active
Broad-Spectrum UV Filter System
Standing
first line — a regulator recognises it for this use; trials support it · per Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products (recast) — Annex VI, List of UV filters allowed in cosmetic products (Official Journal of the European Union L 342, 22.12.2009, via EUR-Lex (PDF)), opened September 1, 2026
Form
plausible — studied range 10%, from the OTC monograph or label; needs leave-on contact
Tolerability
standard
Row checked
against its sources on September 1, 2026 (evidence table ev-2026.09-r228)

The studies behind the evidence row

All sun damage products →
Full protectionfor AgingBroad-spectrum SPF 50 with avobenzone, bemotrizinol (Tinosorb S), Uvinul A Plus, bisoctrizole (Tinosorb M): the protection aging calls for.Limited evidenceStandard tolerabilityNo reviews collected yet

The case for it

  1. Ferulic Acid has early or mechanistic evidence for this concern, not trial-backed standing.
  2. It is plausibly present at a working level, though the concentration is not declared.
  3. The formula carries no trigger this concern is sensitive to, with the cautions noted.

What would change this: A declared concentration would move this to a firmer reading of the dose.

Same rule for everyone. “Full protection” is the verdict on 2,288 of 45,024 concern verdicts across the catalog; rule P1 decided 2,232 of them. Unchanged since September 5, 2026, engine 5.1.1.

Brand or formulator? Disclose a concentration or correct a fact →

Show the work
Rule
P1 — Photoprotection standing is regulatory (M020 / Annex VI filters; 21 CFR 201.327 attaches the early-skin-aging claim to tested broad-spectrum SPF 15+). SPF 30 is the AAD daily-use bar. · the full register
Carrying active
Ferulic Acid
Standing
plausible — trials support it
Form
plausible — studied range 0.5–1%, from the OTC monograph or label; needs leave-on contact
Tolerability
standard
Row checked
against its sources on July 17, 2026 (evidence table ev-2026.09-r228)

The studies behind the evidence row

All aging products →

Does the jobDoes what a sunscreen is for: UVA coverage, holds up in sunlight. Not measured from the label: pleasant enough to actually use.

A verdict is DermApproved’s assessment of how well a product’s ingredients fit a concern — never a claim about what the product treats. Evidence dots and collected reviews sit beside it and are never blended in. Rules 0.5.1 · evidence table ev-2026.09-r228 · how we decide

Assessment

Pros & Cons

Pros

  • ✓ Four-filter European UV system prioritizes deep UVA coverage for melasma
  • ✓ Nonapeptide-1 actively supports pigmentation control beyond basic SPF
  • ✓ Ferulic acid and vitamin E provide layered antioxidant backup
  • ✓ Minimal white cast thanks to filter-based (not mineral) approach
  • ✓ Rich cushiony texture works well on dry and mature skin
  • ✓ Doesn't pill under makeup if given time to absorb
  • ✓ Backed by Pierre Fabre's dermatology research heritage
  • ✓ Pregnancy safe and widely tolerated by sensitive skin

Cons

  • ✗ Small 40ml tube finishes in 6-8 weeks at proper dose
  • ✗ Light fragrance may bother the most reactive skin
  • ✗ Too rich for oily skin types in warm weather
  • ✗ Price per ml is higher than drugstore alternatives
  • ✗ Needs 2-3 minutes to settle before makeup application
Review

Full Review

There are a lot of sunscreens marketed for dark spots, and most of them are just a standard SPF 50 with a sticker slapped on the front. Ducray Melascreen UV Rich is one of the few that actually deserves the category name, and the reason comes down to which UV filters are inside the tube. Melasma and post-inflammatory hyperpigmentation aren't driven by the same wavelengths that cause sunburn — the real culprit is long-wave UVA and, increasingly in the research, visible light. A drugstore SPF 50 can meet the UVB number easily while leaving the UVA side half-protected. Ducray built this formula around Tinosorb S, Tinosorb M, Uvinul A Plus, and Uvinul T 150 — a quartet of modern European filters specifically chosen for deep UVA photostability. That's the whole reason this product exists, and it's the reason dermatologists in Europe hand it to melasma patients when the over-the-counter American SPF shelf lets them down. Read the INCI closely and you'll find the quartet is actually reinforced further — avobenzone and ethylhexyl salicylate round out the filter load, giving the formula redundancy across the spectrum rather than a single point of failure.

The pedigree behind that engineering is worth a sentence. Ducray has been a French pharmacy fixture since 1930 and sits inside the Pierre Fabre dermatological group, whose research labs develop these formulas alongside actual pigmentation clinics. The Melascreen range began life as a targeted depigmenting routine for patients recovering from melasma, and this Rich version exists because drier skin needed more emollient support under the heavy filter load. That's a very different origin than a marketing team discovering that 'dark spot' searches well.

The filter system alone would make this a strong recommendation, but Ducray layered in two more actives that matter for pigmentation-prone skin. The first is Nonapeptide-1, a peptide that interferes with the alpha-MSH signaling pathway — the molecular conversation that tells melanocytes to make more pigment. If you're skeptical that a peptide can do anything from inside a sunscreen, the counterpoint is contact time: an SPF worn eight-plus hours a day delivers its water-phase actives as reliably as most serums do. The second is ferulic acid, a well-studied antioxidant that neutralizes the free radicals generated by the small percentage of UV and visible light that always slips past even the best sunscreen, with tocopherol backing it up on the lipid-soluble side. Together they create a layered defense: filters block the trigger, ferulic mops up the oxidative byproducts, and the peptide quietly nudges the pigmentation pathway back toward baseline. It's not a replacement for tranexamic acid or azelaic acid or whatever else you're using at night, but it's meaningful sun-adjacent support.

Texture-wise, this is firmly in the 'Rich' camp, as the name promises. It comes out of the white-and-orange flip-cap tube as a cushiony white cream that needs about thirty seconds of massage to absorb and maybe another minute or two to fully settle. Dry and normal skin will love it. Oily skin in July will not. The finish lands somewhere between satin and matte — not glowing, not greasy, just comfortable. There's a faint pharmacy-style fragrance on application that disappears quickly; sensitive-skin users who are fragrance-phobic should know it's there, but it's far from the perfumed white cream you'd find on a department store counter. The white cast is minimal on most skin tones thanks to the filter-based (rather than mineral-based) approach, though like any high-filter-load SPF it can leave a trace of residue on very deep skin tones in harsh light.

Where the formula earns its price is consistency of wear. A lot of 'prescription-grade' European sunscreens feel great for an hour and then start to slide under makeup by lunch. Melascreen Rich holds its place reasonably well and doesn't pill if you give it the 2-3 minutes it wants before foundation. Reapplication over makeup is the usual sunscreen struggle — a powder SPF or mist is your friend here. Worth noting for the audience most likely to need it: the formula is considered pregnancy-safe, which matters because pregnancy is one of melasma's most common triggers and exactly the moment many people go searching for a serious UVA shield. The twelve hundred or so reviews averaging 4.4 tell a consistent story — users credit it with actually holding their pigmentation progress through summer, and the complaints are the tube size, the whisper of fragrance, and the richness in humidity, not the protection.

The limitations: the tube is 40ml, which is on the small side for an SPF in this price bracket. If you're applying the proper two-finger-length dose every morning (and you should be, because an underapplied SPF 50 is an SPF 20), you'll finish this in 6-8 weeks. That works out to a non-trivial monthly sunscreen budget, especially if you're also paying for the rest of a melasma routine. The fragrance, mild as it is, also keeps it off the list for the most reactive skin.

But if you're actively treating hyperpigmentation — and especially if you've been pouring money into serums only to watch your spots flare every summer — this is where a lot of your protection budget should go. The nighttime treatment does less than you think. The morning sunscreen does more than you think. And a sunscreen built around the actual wavelengths driving your pigmentation is worth paying for. Ducray has been doing this since the 1930s, and Melascreen is what that kind of institutional dermatology knowledge looks like when it ends up in a tube.

Formula

Key Ingredients

The hero actives that drive this product's performance.

IngredientFunctionEvidence
Broad-Spectrum UV Filter System (Tinosorb S, Tinosorb M, Uvinul A Plus, Uvinul T 150) A carefully constructed photostable filter matrix that combines four modern European filters to deliver SPF 50+ with strong UVA protection — essential in this product because preventing UVA-driven pigmentation is the entire reason Melascreen exists. The filter load is heavier than a standard daily SPF to block the exact wavelengths that trigger melasma and post-inflammatory hyperpigmentation. Regulator-approved for Sun Damage · limited certainty
Nonapeptide-1 A melanogenesis-modulating peptide that interferes with the alpha-MSH pathway, helping reduce pigment transfer while the sunscreen filters block UV triggers. Pairing it with SPF 50+ is the point — the peptide works on existing pigment pathways while the filters prevent new melanin from being stimulated. Not yet assessed
Ferulic Acid Works as an antioxidant backup to the UV filters, neutralizing free radicals generated by the small percentage of UV and visible light that always gets through. In a pigmentation-focused formula, this matters because oxidative stress is one of the triggers that tells melanocytes to ramp up production. Limited for Sun Damage
Tocopherol (Vitamin E) Stabilizes the sunscreen system and supplies lipid-soluble antioxidant defense that complements the water-soluble ferulic acid. In a rich cream base like this one, it also helps prevent oxidation of the emollients during the product's shelf life. Limited for Sun Damage
Full INCI List

Aqua, Ethylhexyl Salicylate, C12-15 Alkyl Benzoate, Butyl Methoxydibenzoylmethane, Bis-Ethylhexyloxyphenol Methoxyphenyl Triazine, Diethylamino Hydroxybenzoyl Hexyl Benzoate, Ethylhexyl Triazone, Glycerin, Cyclopentasiloxane, Methylene Bis-Benzotriazolyl Tetramethylbutylphenol, Propylene Glycol, Cetearyl Alcohol, Cetyl Alcohol, PEG-100 Stearate, Glyceryl Stearate, Phenoxyethanol, Tocopherol, Nonapeptide-1, Ferulic Acid, Xanthan Gum, Disodium EDTA, Parfum

Safety & Formulation Facts
✓ Pregnancy Safe ✗ Fragrance Free✓ Alcohol Free✗ Oil Free✗ Silicone Free✓ Paraben Free✓ Sulfate Free✗ Cruelty Free✗ Vegan✗ Fungal Acne Safe
Comedogenic Ingredients
C12-15 Alkyl Benzoate
Potential Irritants
Parfum
Common Allergens
Parfum
Compatibility

Skin Match

Works For
Not Ideal For
Routine Step

sunscreen

Time of Day

AM

Layering Tips

Save this for the last step of your morning routine over serums and moisturizer. Use a generous two-finger-length dose on the face to achieve labelled SPF. Reapply every two hours with sun exposure.

Results Timeline

UV protection is immediate upon application. Pigmentation prevention is visible over 8-12 weeks of daily use when combined with targeted treatments; meaningful fading of existing spots typically requires 3-6 months of consistent photoprotection.

Pairs Well With
vitamin-cniacinamidetranexamic-acidazelaic-acid
Planning a combo? Check it against what you already use
Sample AM Routine
  1. Gentle cleanser
  2. Vitamin C serum
  3. Moisturizer
  4. Ducray Melascreen UV Rich Cream SPF 50+
Sample PM Routine
  1. Gentle cleanser
  2. Tranexamic acid or azelaic acid treatment
  3. Moisturizer
Evidence

Science & Expert Perspective

The Science

The core evidence behind this product rests on photoprotection research into long-wave UVA and the specific filters in the formula. Tinosorb S (Bis-Ethylhexyloxyphenol Methoxyphenyl Triazine) and Tinosorb M (Methylene Bis-Benzotriazolyl Tetramethylbutylphenol) are photostable broad-spectrum filters with published absorption spectra extending well into the UVA1 range (340-400nm), which is the wavelength band most implicated in melasma pathogenesis. Uvinul A Plus (Diethylamino Hydroxybenzoyl Hexyl Benzoate) is a dedicated UVA filter with peak absorption near 354nm. Ethylhexyl Triazone (Uvinul T 150) contributes strong UVB coverage to the matrix. Published photobiology research consistently identifies UVA1 and visible light as dominant drivers of melanogenesis in melasma patients, and clinical guidelines for melasma management from groups like the Global Melasma Expert Panel specifically recommend sunscreens with high UVA protection factors rather than high SPF numbers alone. On the active side, ferulic acid has well-documented antioxidant activity and has been shown in published work to stabilize vitamin C and vitamin E against oxidative degradation while providing independent free-radical scavenging. Nonapeptide-1 is a synthetic peptide studied for its ability to bind to the melanocortin-1 receptor and modulate alpha-MSH signaling; the evidence base is more limited than for tranexamic acid or azelaic acid, and clinical data is primarily from smaller in-vitro and vendor-led studies, which is why we classify it as 'promising' rather than 'well-established.' The formulation philosophy — heavy UVA load plus antioxidant and pathway support — aligns with current dermatological thinking on melasma management.

Dermatologist Perspective

Dermatologists who specialize in pigmentation disorders frequently recommend European-filter sunscreens for melasma patients because the UVA protection factor is typically higher than American-market SPFs, which matters enormously for a condition driven largely by long-wave UVA and visible light. Products in the Ducray Melascreen range are commonly suggested alongside tranexamic acid, azelaic acid, or hydroquinone treatments in European clinical practice. Practicing dermatologists have long observed that photoprotection is the single most important component of any melasma protocol — the active treatments do little without aggressive daily sun protection, and the choice of sunscreen is where many patients unknowingly sabotage their progress. The Rich formulation is typically suggested for drier, more mature skin or winter use, with the Light version offered for oilier skin or humid climates. Dermatologists also emphasize that tinted versions provide additional iron oxide protection against visible light, which this untinted formula does not address.

Guidance

Usage & Recommendations

How to Use

Apply as the final step of your morning routine, after serums and moisturizer. Use approximately two finger-lengths of product (about 1/4 teaspoon) for face and neck — underapplication is the single biggest reason people don't get the labelled SPF. Let it settle for 2-3 minutes before applying makeup to prevent pilling. Reapply every two hours during prolonged sun exposure, or after swimming or heavy sweating. For melasma management, use daily year-round, including cloudy days and indoor near-window hours, since UVA penetrates glass. Pair in the evening with tranexamic acid, azelaic acid, or another pigmentation-targeted treatment for best results.

Value Assessment

At approximately $32 for 40ml, Melascreen UV Rich sits in the upper-mid tier of pharmacy sunscreens and below true luxury SPFs. The per-ml price is higher than drugstore options, but the filter system is objectively more sophisticated than anything sold in American drugstores, and the pigmentation-targeted formulation is rare at any price point. For someone actively managing melasma or persistent hyperpigmentation, this is genuinely worth the premium — the daily sunscreen is the highest-leverage product in a pigmentation routine, and skimping here undermines everything else. For general daily sun protection without specific pigmentation concerns, cheaper broad-spectrum options from La Roche-Posay or Bioderma deliver comparable base protection for less money. Other sizes are not widely available in this specific formula; the 40ml tube is the standard.

Who Should Buy

Anyone actively managing melasma, post-inflammatory hyperpigmentation, or persistent sun-induced dark spots, especially with dry, normal, or mature skin. It's also an excellent daily SPF for people in high-UV climates who want meaningful UVA coverage without chasing a luxury price tag.

Who Should Skip

Oily or acne-prone skin in warm weather will find the Rich texture too heavy — reach for Melascreen UV Light instead. Anyone with severe fragrance sensitivity should also consider an unscented alternative, and those on a strict budget can get solid basic sun protection from cheaper pharmacy options.

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Details

Product Details

Texture

Rich, cushiony cream that feels more like a moisturizing treatment than a typical sunscreen

Scent

Light, clean pharmacy-style fragrance

Packaging

White and orange squeeze tube with flip cap

Finish
satinnon-greasy
What to Expect on First Use

Goes on as a thicker-than-average SPF cream that takes about a minute to settle into the skin. First-time users often notice a faint residue that disappears after a minute or two of absorption. No stinging or tingling on most skin; very mild fragrance is detectable on application but fades quickly.

How Long It Lasts

Approximately 6-8 weeks with daily face and neck use at the recommended two-finger dose

Period After Opening

12 months

Opened yours? Track the toss-by date
Best Season

All Year

Background

The Story Behind This Product

Developed by Ducray's dermatological lab as part of the Melascreen range, which began as a targeted depigmenting routine for patients recovering from melasma and post-inflammatory hyperpigmentation. The Rich version was created specifically for drier skin types that needed more emollient support alongside the high filter load.

About Ducray Legacy Brand (20+ years)

Ducray is a French pharmacy brand founded in 1930 and owned by the Pierre Fabre dermatological group. It has been distributed through European pharmacies for decades and its products are frequently recommended by dermatologists for pigmentation disorders, with formulations developed alongside the group's dermatological research laboratories.

Brand founded: 1930 · Product launched: 2018
Myth vs. Reality

Common Myths

Myth

Any SPF 50 is enough to prevent melasma flare-ups

Reality

Melasma is primarily driven by UVA and visible light, not UVB. This formula is built around deep UVA filters like Tinosorb S and Uvinul A Plus — many drugstore SPF 50s meet the UVB number but offer far less UVA coverage.

Myth

A peptide in a sunscreen can't do anything because SPF products are meant to sit on top of skin

Reality

Nonapeptide-1 is formulated here in an aqueous-compatible phase that penetrates alongside other actives during the 8+ hours of wear, and its effect compounds with the photoprotection rather than replacing it.

FAQ

Frequently Asked Questions

Is Ducray Melascreen UV Rich SPF 50 good for melasma?

Yes — it was specifically designed for pigmentation-prone skin. The four-filter system prioritizes UVA coverage (the main melasma driver), and the addition of Nonapeptide-1 and ferulic acid supports pigmentation control beyond basic sun protection.

Does Melascreen Rich leave a white cast?

The formula is filter-based rather than mineral-based, so white cast is minimal on most skin tones. A very light initial residue disappears within 1-2 minutes of application.

Can I use this if I have oily skin?

The Rich version runs on the heavier side — oily or combination skin in warm weather may prefer Ducray's Melascreen UV Light Cream instead. Rich is best on dry, dehydrated, or mature skin that needs the extra emollience.

Is Melascreen Rich pregnancy safe?

Yes. Nonapeptide-1 and ferulic acid have no pregnancy contraindications, and the filter system is on the European approved list. Always consult your physician if you have a high-risk pregnancy.

How much should I apply?

Use approximately two finger-lengths (1/4 teaspoon) for face and neck to achieve the labelled SPF 50+ protection. Underapplying — which most users do — cuts the real-world SPF dramatically.

Can I use it under makeup?

Yes, but give it a full 2-3 minutes to absorb before applying foundation. The rich texture can pill if makeup is applied too quickly.

Reviews

What Reviewers Tend to Say

Recurring themes our editors read across retailer reviews of this product — summaries in our words, not quotations, and not a substitute for your own patch test.

Common Praise

Comfortable rich texture

No white cast on most skin tones

Genuinely helps maintain pigmentation progress

Broad-spectrum UVA coverage

Common Complaints

Small 40ml tube for the price

Slight fragrance

Too rich for oily skin in humid weather

Notable Endorsements
Frequently recommended in French dermatology offices for melasma patients