Melasma Treatment: An Evidence-Based Review

Area of Science:

• Dermatology
• Medical Aesthetics

Background:

• Melasma is a chronic, acquired pigmentary disorder impacting women's quality of life.
• Current melasma treatments offer variable results.

Purpose of the Study:

• To conduct an evidence-based review of all available melasma interventions.
• To synthesize findings on the efficacy and safety of various melasma treatments.

Main Methods:

• Systematic literature search of PubMed and Cochrane databases up to October 2018.
• Inclusion of randomized controlled trials and controlled clinical trials in English-language journals.
• Analysis of 113 studies involving 6897 participants.

Main Results:

• Triple combination cream (hydroquinone, tretinoin, corticosteroid) and hydroquinone monotherapy are the most effective topical treatments.
• Chemical peels and laser/light therapies show mixed results and a higher risk of adverse effects.
• Oral tranexamic acid is a promising adjunctive treatment for moderate to severe recurrent melasma.

Conclusions:

• Topical hydroquinone and triple combination cream are well-established, effective melasma treatments.
• Non-topical treatments like peels and lasers are comparable or inferior to topicals with increased adverse event risks.
• Oral tranexamic acid warrants further investigation for long-term safety and efficacy in melasma management.