Highlights & Basics
- Melasma is a harmless pigmentary disorder, seen primarily on the malar region of women with darker skin.
- Etiologic factors include hormonal and ultraviolet light exposure.
- Treatment is with topical retinoids, bleaching agents, chemical peels, and laser or light therapy.
- Sun protection is important for maintaining the effects of treatment.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Ball Arefiev KL, Hantash BM. Advances in the treatment of melasma: a review of the recent literature. Dermatol Surg. 2012 Jul;38(7 Pt 1):971-84.[Abstract]
Rajaratnam R, Halpern J, Salim A, et al. Interventions for melasma. Cochrane Database Syst Rev. 2010;(7):CD003583.[Abstract]
Kang HY, Ortonne JP. What should be considered in treatment of melasma. Ann Dermatol. 2010 Nov;22(4):373-8. [Abstract][Full Text]
Austin E, Nguyen JK, Jagdeo J. Topical treatments for melasma: a systematic review of randomized controlled trials. J Drugs Dermatol. 2019 Nov 1;18(11):S1545961619P1156X.[Abstract][Full Text]
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11. Ortonne JP, Arellano I, Berneburg M, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23:1254-62.[Abstract]
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13. Kang HY, Ortonne JP. What should be considered in treatment of melasma. Ann Dermatol. 2010 Nov;22(4):373-8. [Abstract][Full Text]
14. Torres-Álvarez B, Mesa-Garza IG, Castanedo-Cázares JP, et al. Histochemical and immunohistochemical study in melasma: evidence of damage in the basal membrane. Am J Dermatopathol. 2011;33:291-295.[Abstract]
15. Miot LD, Miot HA, Polettini J, et al. Morphologic changes and the expression of alpha-melanocyte stimulating hormone and melanocortin-1 receptor in melasma lesions: a comparative study. Am J Dermatopathol. 2010;32:676-682.[Abstract]
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25. Kang HY, Valerio L, Bahadoran P, et al. The role of topical retinoids in the treatment of pigmentary disorders: an evidence-based review. Am J Clin Dermatol. 2009;10(4):251-60. [Abstract]
26. Taylor SC, Torok H, Jones T, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis. 2003 Jul;72(1):67-72.[Abstract]
27. Chan R, Park KC, Lee MH, 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. Br J Dermatol. 2008 Sep;159(3):697-703.[Abstract]
28. Arellano I, Cestari T, Ocampo-Candiani J, et al. Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long-standing clinical severity. J Eur Acad Dermatol Venereol. 2012 May;26(5):611-8.[Abstract]
29. Austin E, Nguyen JK, Jagdeo J. Topical treatments for melasma: a systematic review of randomized controlled trials. J Drugs Dermatol. 2019 Nov 1;18(11):S1545961619P1156X.[Abstract][Full Text]
30. Prignano F, Ortonne JP, Buggiani G, et al. Therapeutical approaches in melasma. Dermatol Clin. 2007 Jul;25(3):337-42, viii.[Abstract]
31. Verallo-Rowell VM, Verallo V, Graupe K, et al. Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. Acta Derm Venereol Suppl (Stockh). 1989;143:58-61.[Abstract]
32. Balina LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. 1991 Dec;30(12):893-5.[Abstract]
33. Deo KS, Dash KN, Sharma YK, et al. Kojic acid vis-a-vis its combinations with hydroquinone and betamethasone valerate in melasma: a randomized, single blind, comparative study of efficacy and safety. Indian J Dermatol. 2013 Jul;58(4):281-5.[Abstract][Full Text]
34. Leyden JJ, Shergill B, Micali G, et al. Natural options for the management of hyperpigmentation. J Eur Acad Dermatol Venereol. 2011 Oct;25(10):1140-5.[Abstract]
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37. Sobhi RM, Sobhi AM. 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. J Cosmet Dermatol. 2012 Mar;11(1):65-71.[Abstract]
38. Draelos ZD. Skin lightening preparations and the hydroquinone controversy. Dermatol Ther. 2007 Sep-Oct;20(5):308-13.[Abstract]
39. Gupta AK, Gover MD, Nouri K, et al. The treatment of melasma: a review of clinical trials. J Am Acad Dermatol. 2006 Dec;55(6):1048-65.[Abstract]
40. Putra IB, Jusuf NK, Dewi NK. Skin changes and safety profile of topical products during pregnancy. J Clin Aesthet Dermatol. 2022 Feb;15(2):49-57.[Abstract][Full Text]
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42. Chun EY, Lee JB, Lee KH. Focal trichloroacetic acid peel method for benign pigmented lesions in dark-skinned patients. Dermatol Surg. 2004 Apr;30(4 Pt 1):512-6.[Abstract]
43. Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999 Jan;25(1):18-22.[Abstract][Full Text]
44. Javaheri SM, Handa S, Kaur I, et al. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol. 2001 May;40(5):354-7.[Abstract]
45. Soliman MM, Ramadan SA, Bassiouny DA, et al. Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study. J Cosmet Dermatol. 2007 Jun;6(2):89-94.[Abstract]
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48. Rokhsar CK, Fitzpatrick RE. The treatment of melasma with fractional photothermolysis: a pilot study. Dermatol Surg. 2005 Dec;31(12):1645-50.[Abstract]
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50. Tierney EP, Hanke CW. Review of the literature: Treatment of dyspigmentation with fractionated resurfacing. Dermatol Surg. 2010 Oct;36(10):1499-508.[Abstract]
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52. Tannous Z. Fractional resurfacing. Clin Dermatol. 2007 Sep-Oct;25(5):480-6.[Abstract]
53. Tehrani S, Tehrani S, Esmaili-Azad M, et al. Efficacy and safety of azelaic acid 20% plus hydroquinone 5% in the management of melasma. Iran J Dermatol. 2012;15:11-14.
54. Kodali S, Guevara IL, Carrigan CR, et al. A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women. J Am Acad Dermatol. 2010 Dec;63(6):1030-5. [Abstract]
55. Figueiredo Souza L, Trancoso Souza S. Single-session intense pulsed light combined with stable fixed-dose triple combination topical therapy for the treatment of refractory melasma. Dermatol Ther. 2012 Sep-Oct;25(5):477-80.[Abstract]
56. Kim SJ, Park JY, Shibata T, et al. Efficacy and possible mechanisms of topical tranexamic acid in melasma. Clin Exp Dermatol. 2016 Jul;41(5):480-5.[Abstract]
57. Kim HJ, Moon SH, Cho SH, et al. Efficacy and safety of tranexamic acid in melasma: a meta-analysis and systematic review. Acta Derm Venereol. 2017 Jul 6;97(7):776-81. [Abstract][Full Text]
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59. Sharma R, Mahajan VK, Mehta KS, et al. Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clin Exp Dermatol. 2017 Oct;42(7):728-34.[Abstract]
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62. Mansouri P, Farshi S, Hashemi Z, et al. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015 Jul;173(1):209-17.[Abstract][Full Text]
63. Tirado-Sanchez A, Santamaría-Roman A, Ponce-Olivera RM. Efficacy of dioic acid compared with hydroquinone in the treatment of melasma. Int J Dermatol. 2009 Aug;48(8):893-5. [Abstract]
64. Khemis A, Kaiafa A, Queille-Roussel C, et al. Evaluation of efficacy and safety of rucinol serum in patients with melasma: a randomized controlled trial. Br J Dermatol. 2007 May;156(5):997-1004. [Abstract]
65. Huh SY, Shin JW, Na JI, et al. The efficacy and safety of 4-n-butylresorcinol 0.1% cream for the treatment of melasma: a randomized controlled split-face trial. Ann Dermatol. 2010 Feb;22(1):21-5. [Abstract]
66. Ni Z, Mu Y, Gulati O. Treatment of melasma with Pycnogenol. Phytother Res. 2002 Sep;16(6):567-71.[Abstract]
67. Handog EB, Galang DA, de Leon-Godinez MA, et al. A randomized, double-blind, placebo-controlled trial of oral procyanidin with vitamins A, C, E for melasma among Filipino women. Int J Dermatol. 2009 Aug;48(8):896-901.[Abstract]
68. Yi X, Zhao G, Zhang H, et al. MITF-siRNA formulation is a safe and effective therapy for human melasma. Mol Ther. 2011 Feb;19(2):362-71.[Abstract]
69. Ilknur T, Biçak MU, Demirtaşoğlu M, et al. Glycolic acid peels versus amino fruit acid peels in the treatment of melasma. Dermatol Surg. 2010 Apr;36(4):490-5[Abstract]
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