Melasma Treatment: An Evidence-Based Review

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



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


Abstract: Melasma is an acquired, chronic pigmentary disorder that predominantly affects women. It can significantly affect the quality of life and self-esteem due to its ugly appearance. There are numerous treatments for melasma, with mixed results.


Objective: The purpose of this article was to conduct an evidence-based review of all available interventions for melasma.


Methods: A systematic literature search of the electronic database PubMed was conducted using the keywords 'melasma' and/or 'chloasma' in the title, up to October 2018. The search was then limited to 'randomised controlled trials' 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. The triple combination cream (hydroquinone, tretinoin, and corticosteroids) 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 to 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, while chemical peels and laser- and light-based therapies are equal or inferior to current ones but offer a higher risk of high side effects. Oral tranexamic acid may be a safe and 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 and more rigorous studies in the treatment of this disorder.