What it means for a patient
- Melasma is common in women and is linked to sun exposure.
- The authors state broad-spectrum sunscreen is important in treatment.
- Hydroquinone creams are the most common treatment. Combinations with tretinoin and a steroid may work better than one agent alone.
- Melasma often comes back after treatment.
- Several newer lightening agents did not yet have enough evidence to be recommended.
- Peels, lasers and light treatments are listed as options. The abstract does not rate their results.
- This is a review. The abstract gives no numbers.
Why this paper matters
It reviewed clinical trials of melasma treatments and separated the agents in common use from those needing more study.
Overview
Melasma is irregular brown or grayish-brown darkening of the facial skin. It often affects women, especially those living where UV radiation is intense. Its exact cause is unknown. The authors review clinical trials of melasma treatments.
Findings
- Melasma: irregular brown or grayish-brown facial hyperpigmentation, often in women, especially in areas of intense UV radiation.
- The precise cause is unknown; there are many possible contributing factors.
- It is often difficult to treat because of its dermal component and its tendency to relapse.
- Broad-spectrum (UVA and UVB) sunscreen is important.
- Topical hydroquinone is the most common treatment.
- Other lightening agents: tretinoin (retinoic acid) and azelaic acid.
- Combination therapy with hydroquinone, tretinoin and a corticosteroid is thought to be more effective than a single agent.
- Kojic acid, isopropylcatechol, N-acetyl-4-cysteaminylphenol and flavonoid extracts would need further study before they could be recommended, because of their efficacy, safety or trial design.
- Chemical peels, laser treatments and intense pulsed light have also been used.
- The abstract gives no trial counts or success rates.
Terms
- Melasma: patchy brown or gray-brown darkening of the face.
- Hypermelanosis: darkening of the skin from extra melanin pigment.
- Dermal component: pigment that sits in the deeper layer of the skin, which is harder to treat.
- Hydroquinone: a cream that lightens dark skin patches.
- Tretinoin (retinoic acid): a vitamin A cream that speeds skin cell turnover.
- Azelaic acid: a cream used to lighten pigment and treat acne.
- Broad-spectrum sunscreen: sunscreen that blocks both UVA and UVB light.
- Monotherapy: treatment with a single agent.
- Chemical peel: an acid applied to the skin to remove its outer layers.
- Intense pulsed light: a light-based treatment that targets pigment and blood vessels.