Evidence-Based Treatment for Melasma: Expert Opinion and a Review Krupa ShankarKiran GodseSanjeev AurangabadkarKoushik LahiriVenkat Mysore • Anil GanjooMaya VedamurtyMalavika KohliJaishree SharadGanesh Kadhe • Pashmina AhirraoVarsha NarayananSalman Abdulrehman Motlekar

Introduction: Melasma is one of the most common pigmentary disorders seen by dermatologists and often occurs among women with darker complexion (Fitzpatrick skin type IV–VI). Even though melasma is a

[1]  R. Bhat,et al.  A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Facial Melasma , 2013, Indian journal of dermatology.

[2]  V. Garg,et al.  Chemical Peels for Melasma in Dark-Skinned Patients , 2012, Journal of cutaneous and aesthetic surgery.

[3]  Soyun Cho,et al.  Intense Pulsed Light and Low-Fluence Q-Switched Nd:YAG Laser Treatment in Melasma Patients , 2012, Annals of dermatology.

[4]  K. Godse,et al.  Mometasone Menace in Melasma , 2012, Indian journal of dermatology.

[5]  Yi Sun,et al.  Treatment of Melasma With Oral Administration of Tranexamic Acid , 2012, Aesthetic Plastic Surgery.

[6]  A. Manosroi,et al.  Topical 5% tranexamic acid for the treatment of melasma in Asians: A double-blind randomized controlled clinical trial , 2012, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[7]  R. Sobhi,et al.  A single‐blinded comparative study between the use of glycolic acid 70% peel and the use of topical nanosome vitamin C iontophoresis in the treatment of melasma , 2012, Journal of cosmetic dermatology.

[8]  S. Farshi.  Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma , 2011, Journal of cosmetic dermatology.

[9]  A. Aggarwal,et al.  Melasma: Treatment strategy , 2011, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[10]  Vaneeta M. Sheth,et al.  Melasma: a comprehensive update: part I. , 2011, Journal of the American Academy of Dermatology.

[11]  K. C. Nischal,et al.  Fractional lasers in dermatology--current status and recommendations. , 2011, Indian journal of dermatology, venereology and leprology.

[12]  K. Godse,et al.  Triple combination and glycolic acid peels in melasma in Indian patients , 2011, Journal of cosmetic dermatology.

[13]  A. Schettini,et al.  Ocronose exógena induzida por hidroquinona: relato de quatro casos , 2010 .

[14]  I. Majid.  MOMETASONE-BASED TRIPLE COMBINATION THERAPY IN MELASMA: IS IT REALLY SAFE? , 2010, Indian journal of dermatology.

[15]  N. Kollias,et al.  Impact of long-wavelength UVA and visible light on melanocompetent skin. , 2010, The Journal of investigative dermatology.

[16]  J. Halpern,et al.  Interventions for melasma. , 2010, The Cochrane database of systematic reviews.

[17]  M. Rendon,et al.  Evidence and considerations in the application of chemical peels in skin disorders and aesthetic resurfacing. , 2010, The Journal of clinical and aesthetic dermatology.

[18]  R. Kumari,et al.  Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma. , 2010, Indian journal of dermatology, venereology and leprology.

[19]  M. Trelles,et al.  The treatment of melasma with topical creams alone, CO2 fractional ablative resurfacing alone, or a combination of the two: a comparative study. , 2010, Journal of drugs in dermatology : JDD.

[20]  Ai-Young Lee,et al.  H19 RNA downregulation stimulated melanogenesis in melasma , 2010, Pigment cell & melanoma research.

[21]  P. Puri,et al.  Melasma in men: a clinical, aetiological and histological study , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[22]  T. Cestari,et al.  A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[23]  D. Bandyopadhyay.  TOPICAL TREATMENT OF MELASMA , 2009, Indian journal of dermatology.

[24]  Shruti Sharma,et al.  Melasma: a clinicopathological study of 43 cases. , 2009, Indian journal of pathology & microbiology.

[25]  T. C. Rodrigues,et al.  Melasma and pregnancy in southern Brazil , 2009, Journal of the European Academy of Dermatology and Venereology : JEADV.

[26]  S. Feldman,et al.  The prevalence of melasma and its association with quality of life in adult male Latino migrant workers , 2009, International journal of dermatology.

[27]  N. Kerrouche,et al.  A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0·01%, hydroquinone 4%, tretinoin 0·05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma , 2008, The British journal of dermatology.

[28]  I. Hamzavi,et al.  Effects of Visible Light on the Skin † , 2008, Photochemistry and photobiology.

[29]  D. Goldberg,et al.  Histologic and ultrastructural analysis of melasma after fractional resurfacing , 2008, Lasers in surgery and medicine.

[30]  A. Katsambas,et al.  Hyperpigmentation and melasma , 2007, Journal of cosmetic dermatology.

[31]  Z. Draelos.  Skin lightening preparations and the hydroquinone controversy , 2007, Dermatologic therapy.

[32]  Y. Boo,et al.  Mechanisms of melanogenesis inhibition by 2,5‐dimethyl‐4‐hydroxy‐3(2H)‐furanone , 2007, The British journal of dermatology.

[33]  J. Ortonne,et al.  Therapeutical approaches in melasma. , 2007, Dermatologic clinics.

[34]  K. Hassun,et al.  A comparison of triple combination cream and hydroquinone 4% cream for the treatment of moderate to severe facial melasma , 2007, Journal of cosmetic dermatology.

[35]  Stacey K Naito.  Fractional photothermolysis treatment for resistant melasma in Chinese females , 2007, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[36]  Francisco Solano,et al.  Hypopigmenting agents: an updated review on biological, chemical and clinical aspects. , 2006, Pigment cell research.

[37]  K. Sharquie,et al.  Lactic Acid Chemical Peels as a New Therapeutic Modality in Melasma in Comparison to Jessner's Solution Chemical Peels , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[38]  C. Lynde,et al.  Topical treatments for melasma and postinflammatory hyperpigmentation. , 2006, Skin therapy letter.

[39]  H. Chan,et al.  Pigmentary disorders in Asian skin: treatment with laser and intense pulsed light sources. , 2006, Skin therapy letter.

[40]  M. Picardo,et al.  Treatment of melasma. , 2006, Journal of the American Academy of Dermatology.

[41]  Mi-Yeon Kim,et al.  Localized Intradermal Microinjection of Tranexamic Acid for Treatment of Melasma in Asian Patients: A Preliminary Clinical Trial , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[42]  E. Berardesca,et al.  Clinical and Instrumental Evaluation of Skin Improvement after Treatment with a New 50% Pyruvic Acid Peel , 2006, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[43]  N. Fallah,et al.  Prevalence and awareness of melasma during pregnancy , 2006, International journal of dermatology.

[44]  R. Fitzpatrick,et al.  The Treatment of Melasma with Fractional Photothermolysis: A Pilot Study , 2005, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[45]  Susan C. Taylor,et al.  A large 12-month extension study of an 8-week trial to evaluate the safety and efficacy of triple combination (TC) cream in melasma patients previously treated with TC cream or one of its dyads. , 2005, Journal of drugs in dermatology : JDD.

[46]  P. Kulhalli,et al.  Comparative potency of formulations of mometasone furoate in terms of inhibition of 'PIRHR' in the forearm skin of normal human subjects measured with laser doppler velocimetry. , 2005, Indian journal of dermatology, venereology and leprology.

[47]  P. Grimes,et al.  Light Microscopic, Immunohistochemical, and Ultrastructural Alterations in Patients with Melasma , 2005, The American Journal of dermatopathology.

[48]  Jean-Paul Ortonne,et al.  Melanin pigmentary disorders: treatment update. , 2005, Dermatologic clinics.

[49]  Z. Tannous,et al.  Utilizing fractional resurfacing in the treatment of therapy‐resistant melasma , 2005, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[50]  K. Sharquie,et al.  Lactic Acid as a New Therapeutic Peeling Agent in Melasma , 2005, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[51]  Y. Sue,et al.  Intense Pulsed Light for the Treatment of Refractory Melasma in Asian Persons , 2004, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[52]  B. Moncada,et al.  A double‐blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma , 2004, International journal of dermatology.

[53]  R. Jain,et al.  Tretinoin Peels versus Glycolic Acid Peels in the Treatment of Melasma in Dark‐Skinned Patients , 2004, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[54]  C. Grover,et al.  Efficacy of Hydroquinone (2%) Versus Tretinoin (0.025%) as Adjunct Topical Agents for Chemical Peeling in Patients of Melasma , 2004, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[55]  H. Lim.  Skin in the tropics: sunscreens and hyperpigmentations , 2004 .

[56]  A. Pandya,et al.  Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma , 2003, International journal of dermatology.

[57]  Susan C. Taylor,et al.  Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. , 2003, Cutis.

[58]  H. Eun,et al.  A Randomized, Double-Blind, Placebo-Controlled Trial of Vitamin C Iontophoresis in Melasma , 2003, Dermatology.

[59]  E. Camera,et al.  Chemical and instrumental approaches to treat hyperpigmentation. , 2003, Pigment cell research.

[60]  Alessandra Haddad,et al.  A clinical, prospective, randomized, double‐blind trial comparing skin whitening complex with hydroquinone vs. placebo in the treatment of melasma , 2003, International journal of dermatology.

[61]  C. Grover,et al.  The therapeutic value of glycolic acid peels in dermatology. , 2003, Indian journal of dermatology, venereology and leprology.

[62]  N. Polnikorn,et al.  Combined Ultrapulse CO2 Laser and Q‐Switched Alexandrite Laser Compared with Q‐Switched Alexandrite Laser Alone for Refractory Melasma: Split‐Face Design , 2003, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[63]  Gayoung Lee,et al.  The Effect of Combination Treatment of the Recalcitrant Pigmentary Disorders with Pigmented Laser and Chemical Peeling , 2002, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[64]  S. Dogra,et al.  Adapalene in the Treatment of Melasma: A Preliminary Report , 2002, The Journal of dermatology.

[65]  S. Sohn,et al.  Melasma: histopathological characteristics in 56 Korean patients , 2002, The British journal of dermatology.

[66]  A. Katsambas,et al.  Depigmenting and bleaching agents: coping with hyperpigmentation. , 2001, Clinics in dermatology.

[67]  Bhushan Kumar,et al.  Safety and efficacy of glycolic acid facial peel in Indian women with melasma , 2001, International journal of dermatology.

[68]  S. Kunachak,et al.  Dermabrasion: A Curative Treatment for Melasma , 2001, Aesthetic Plastic Surgery.

[69]  T. Iga,et al.  Experience with a Strong Bleaching Treatment for Skin Hyperpigmentation in Orientals , 2000, Plastic and reconstructive surgery.

[70]  V. Leenutaphong,et al.  Topical isotretinoin for melasma in Thai patients: a vehicle-controlled clinical trial. , 1999, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[71]  C. Goh,et al.  A retrospective study on the clinical presentation and treatment outcome of melasma in a tertiary dermatological referral centre in Singapore. , 1999, Singapore medical journal.

[72]  L. Bowes,et al.  Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. , 1999, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[73]  S. Chimenti,et al.  The use of chemical peelings in the treatment of different cutaneous hyperpigmentations. , 1999, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[74]  Frcpi,et al.  Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. , 1999 .

[75]  T. Alster,et al.  Erbium:YAG laser resurfacing for refractory melasma. , 1999, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[76]  Sungnack Lee,et al.  Intermittent Therapy for Melasma in Asian Patients with Combined Topical Agents (Retinoic Acid, Hydroquinone and Hydrocortisone): Clinical and Histological Studies , 1998, The Journal of dermatology.

[77]  J. Lim,et al.  Glycolic Acid Peels in the Treatment of Melasma among Asian Women , 1997, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[78]  J. Fulton,et al.  The Combination of Glycolic Acid and Hydroquinone or Kojic Acid for the Treatment of Melasma and Related Conditions , 1996, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[79]  A. Sivayathorn.  Melasma in Orientals , 1995 .

[80]  D. Kopera,et al.  Ruby laser treatment of melasma and postinflammatory hyperpigmentation. , 1995, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[81]  T. Hamilton,et al.  Topical retinoic acid (tretinoin) for melasma in black patients. A vehicle-controlled clinical trial. , 1994, Archives of dermatology.

[82]  T. Hamilton,et al.  Topical tretinoin (retinoic acid) improves melasma. A vehicle‐controlled, clinical trial , 1993, The British journal of dermatology.

[83]  K. Jimbow.  N-acetyl-4-S-cysteaminylphenol as a new type of depigmenting agent for the melanoderma of patients with melasma. , 1991, Archives of dermatology.

[84]  M. d’Ischia,et al.  Mechanism of inhibition of melanogenesis by hydroquinone. , 1991, Biochimica et biophysica acta.

[85]  Hector J. Maldonado,et al.  Melasma in Men , 1988, International journal of dermatology.

[86]  M. Mihm,et al.  Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. , 1981, Journal of the American Academy of Dermatology.

[87]  T. Fitzpatrick,et al.  Mechanism of depigmentation by hydroquinone. , 1974, The Journal of investigative dermatology.

[88]  Susan C. Taylor,et al.  Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. , 2011, Journal of the American Academy of Dermatology.

[89]  E. Farag,et al.  A STUDY COMPARING CHEMICAL PEELING USING MODIFIED JESSNER'S SOLUTION AND 15%TRICHLOROACETIC ACID VERSUS 15% TRICHLOROACETIC ACID IN THE TREATMENT OF MELASMA , 2009, Indian journal of dermatology.

[90]  K. Godse.  TRIPLE COMBINATION OF HYDROQUINONE, TRETINOIN AND MOMETASONE FUROATE WITH GLYCOLIC ACID PEELS IN MELASMA , 2009, Indian journal of dermatology.

[91]  Niti Khunger.  Standard guidelines of care for chemical peels. , 2008, Indian journal of dermatology, venereology and leprology.

[92]  H. Torok.  A Comprehensive Review of the Long-Term and Short-Term Treatment of Melasma with a Triple Combination Cream , 2006, American journal of clinical dermatology.

[93]  P. Grimes.  The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. , 1999, Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.].

[94]  P. E. Grimes.  Melasma. Etiologic and therapeutic considerations. , 1995, Archives of dermatology.

[95]  V. Verallo-Rowell,et al.  Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. , 1989, Acta dermato-venereologica. Supplementum.

[96]  J. Piquero-Martín,et al.  [Double-blind clinical study of the treatment of melasma with azelaic acid versus hydroquinone]. , 1988 .

[97]  A. Kligman,et al.  A new formula for depigmenting human skin. , 1975, Archives of dermatology.