Interventions for melasma

Area of Science:

• Dermatology
• Cosmetic Science

Background:

• Melasma is a common facial pigmentary disorder characterized by grey-brown patches.
• Current melasma treatments are often unsatisfactory for patients.

Purpose of the Study:

• To evaluate the effectiveness of various topical and systemic interventions for epidermal, dermal, and mixed melasma.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included major databases like Cochrane, MEDLINE, and EMBASE up to May 2010.
• Two authors independently assessed study quality, selected trials, and extracted data.

Main Results:

• Twenty studies with 2125 participants evaluated 23 treatments; data pooling was not feasible due to heterogeneity.
• Triple-combination cream (hydroquinone, tretinoin, fluocinolone acetonide) showed superior efficacy over hydroquinone alone and dual combinations.
• Azelaic acid (20%) was more effective than 2% hydroquinone, and Thiospot demonstrated superiority over placebo. Tretinoin showed mixed results against placebo but improved melasma objectively.
• Common adverse events were mild and transient, including skin irritation.

Conclusions:

• The overall quality of existing melasma treatment studies is poor.
• Current therapeutic options for melasma are inadequate.
• High-quality RCTs with long-term outcome assessments are necessary to guide clinical practice.