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American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 2/2020

01-04-2020 | Intense Pulsed Light | Systematic Review

Melasma Treatment: An Evidence-Based Review

Authors: Jacqueline McKesey, Andrea Tovar-Garza, Amit G. Pandya

Published in: American Journal of Clinical Dermatology | Issue 2/2020

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Abstract

Background

Melasma is an acquired, chronic pigmentary disorder predominantly affecting women. It may significantly affect quality of life and self-esteem due to its disfiguring appearance. Multiple treatments for melasma are available, with mixed results.

Objective

The aim of this article was to conduct an evidence-based review of all available interventions for melasma.

Methods

A systematic literature search of the PubMed electronic database was performed using the keywords ‘melasma’ and/or ‘chloasma’ in the title, through October 2018. The search was then limited to ‘randomized controlled trial’ and ‘controlled clinical trial’ in English-language journals. The Cochrane database was also searched for systematic reviews.

Results

The electronic search yielded a total of 212 citations. Overall, 113 studies met the inclusion criteria and were included in this review, with a total of 6897 participants. Interventions included topical agents, chemical peels, laser- and light-based devices, and oral agents. Triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment for melasma, as well as hydroquinone alone. Chemical peels and laser- and light-based devices have mixed results. Oral tranexamic acid is a promising new treatment for moderate and severe recurrent melasma. Adverse events from all treatments tend to be mild, and mainly consist of skin irritation, dryness, burning, erythema, and post-inflammatory hyperpigmentation.

Conclusions

Hydroquinone monotherapy and triple combination cream are the most effective and well-studied treatments for melasma, whereas chemical peels and laser- and light-based therapies are equal or inferior to topicals, but offer a higher risk of adverse effects. Oral tranexamic acid may be a safe, systemic adjunctive treatment for melasma, but more studies are needed to determine its long-term safety and efficacy. Limitations of the current evidence are heterogeneity of study design, small sample size, and lack of long-term follow-up, highlighting the need for larger, more rigorous studies in the treatment of this recalcitrant disorder.
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Metadata
Title
Melasma Treatment: An Evidence-Based Review
Authors
Jacqueline McKesey
Andrea Tovar-Garza
Amit G. Pandya
Publication date
01-04-2020
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 2/2020
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-019-00488-w

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