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Melasma Treatment: An Evidence-Based Review

  • Systematic Review
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9190, USA

    Jacqueline McKesey & Amit G. Pandya

  2. Uniq Dermatology, Monterrey, Mexico

    Andrea Tovar-Garza

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  1. Jacqueline McKesey
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Jacqueline-McKesey, Andrea Tovar-Garza and Amit G. Pandya have no conflicts of interest to disclose.

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McKesey, J., Tovar-Garza, A. & Pandya, A.G. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol 21, 173–225 (2020). https://doi.org/10.1007/s40257-019-00488-w

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