Melasma Treatment: An Evidence-Based Review

Jacqueline McKesey; Andrea Tovar-Garza; Amit G. Pandya

Disclosures

Am J Clin Dermatol. 2020;21(2):173-225. 

In This Article

Background

Etiology

Melasma is a common, acquired disorder of hyperpigmentation that mainly affects women during childbearing years and has a significant impact on quality of life.[1,2] Although the pathogenesis of this disease remains unclear, several etiologic factors have been identified, including exposure to ultraviolet (UV) radiation and visible light, familial predisposition, pregnancy, and exogenous hormone use.[3–6]

Clinical Features

Melasma presents as bilateral, brown macules or patches on the malar cheeks, forehead, upper lip, and/or mandible, most commonly in a centrofacial pattern.[7] Histologically, melasma is characterized by increased melanin in the epidermis and/or dermis. Clinical examination using Wood's lamp may aid in diagnosis.[5] Unfortunately, the clinical course of melasma is often protracted and resistant to treatment, and melasma often returns after discontinuation of treatment or with increased sun exposure.[7]

Interventions

Current treatments include topical and systemic agents, as well as chemical peels and laser- and light-based therapies. Improvement of existing lesions and prevention of recurrence should be goals of treatment. Topical therapies include depigmenting agents, retinoids, corticosteroids, visible and UV light protection, tranexamic acid (TXA), and combination creams. Commonly used chemical peels include glycolic acid (GA), salicylic acid (SA), and trichloroacetic acid (TCA). Laser- and light-based therapies include intense pulsed light (IPL), Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser, pulsed-dye laser (PDL), fractionated laser, and others. New systemic medications include TXA and plant-based supplements. There are also myriad topical plant-based agents and commercially available skin-brightening therapies that lack scientific evidence of efficacy with rigorous study design.

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