A triple combination cream containing hydroquinone, tretinoin and corticosteroid proved to be the most effective melasma intervention, according to findings of a recent review article.
“The aim of this article was to conduct an evidence-based review of all available interventions for melasma,” Jacqueline McKesey, MD, of the department of dermatology at the University of Texas Southwestern Medical Center, and colleagues wrote. They suggested that the acquired, chronic pigmentary disorder can have detrimental effects on quality of life and self-esteem among the many young women it affects.
Mixed results have been reported for the therapies available on the market, of which there are many, including topical drugs such as depigmenting agents, retinoids and corticosteroids; visible and UV light protection; tranexamic acid; and combination creams. In the chemical peel category are glycolic acid, salicylic acid and trichloroacetic acid. Intense pulsed light, Q-switched neodymium-doped yttrium aluminum garnet laser, pulsed-dye laser and fractionated laser are among the laser- and light-based therapies that underwent analysis, while tranexamic acid and plant-based supplements comprise novel systemic therapies. Clinicians may also use topical plant-based agents and commercially available skin-brightening therapies. However, there are few studies evaluating these options.
The investigators conducted a systematic search of keywords “melasma” or “chloasma” in the PubMed database. Randomized controlled trials or controlled clinical trials in English language journals through October 2018 were included.
Of 212 citations found in the initial search, 113 ultimately met inclusion criteria. There were 6,897 patients included in the final analysis.
Clinicians had treated patients with all of the aforementioned treatment types, including topical agents, chemical peels, laser- and light-based devices and oral agents, according to the findings.
The researchers noted that in addition to the triple combination cream, hydroquinone monotherapy also was most efficacious.
Mixed outcomes were reported for both chemical peels and laser- or light-based devices. These interventions have been associated with an inferior adverse event profile.
There may be hope for oral tranexamic acid as a novel intervention for patients with moderate or severe recurrent melasma, the researchers wrote. However, this systemic adjunctive melasma therapy should undergo more rigorous investigation to clearly define its long-term efficacy and safety.
All of these treatments are associated with mostly mild adverse events. Skin irritation, dryness, burning, erythema and post-inflammatory hyperpigmentation may occur.
Beyond pharmacotherapeutic options, the findings underscore the necessity of sunscreen in patients with melasma.
The researchers acknowledged that many of the studies that underwent analysis were small in size and lacked long-term follow-up data. In addition, study designs were heterogeneous, making it difficult to draw firm conclusions.
“A broader understanding of melasma through further research will potentially give us new and improved therapies in the future,” the researchers concluded. – by Rob Volansky
Disclosures: The authors report no relevant financial disclosures.