Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Area of Science:

• Dermatology
• Hyperpigmentation Disorders

Background:

• Melasma is a prevalent hyperpigmentary disorder, primarily affecting women and individuals with darker skin tones.
• Key causative factors include sun exposure, hormonal fluctuations, pregnancy, and genetic predisposition.
• It is often recalcitrant to treatment, necessitating effective therapeutic strategies.

Purpose of the Study:

• To review current evidence on melasma treatments.
• To propose a treatment algorithm for melasma management, particularly in the Indian context.
• To address the lack of standardized therapeutic guidelines.

Main Methods:

• Review of existing scientific literature on melasma therapies.
• Expert consensus discussion through the South Asian Pigmentary Forum (SPF).
• Development of a suggested treatment algorithm by the Pigmentary Disorders Society (PDS).

Main Results:

• Topical agents like hydroquinone, azelaic acid, and Vitamin C, alongside rigorous sun protection, are mainstays of melasma therapy.
• Emerging botanical and non-botanical agents, along with oral therapies, show future potential.
• A collaborative expert panel developed a treatment algorithm to guide clinical practice.

Conclusions:

• Standardized treatment guidelines for melasma are lacking, especially in South Asia.
• The proposed algorithm offers expert-recommended strategies for managing melasma.
• A combination of established topical treatments, sun protection, and consideration of novel agents is crucial for effective melasma control.