Melasma Treatment: An Evidence-Based Review

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


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

In This Article


Melasma is an acquired chronic condition associated with negative social and psychological effects. Despite multiple treatment modalities being available, topical HQ alone or associated with a retinoid and a corticosteroid is the most studied agent and continues to be the most effective treatment modality. Importantly, sunscreens are essential in the treatment of melasma. Recently, the use of oral TXA has been reported to be a useful adjuvant treatment in subjects with moderate to severe or recalcitrant melasma, and is associated with few adverse effects. Chemical peels and laser- and light-based therapies have mixed results and physicians should be aware of the risk of adverse effects, mainly in dark-skinned subjects. A broader understanding of melasma through further research will potentially give us new and improved therapies in the future.