Melasma Guidelines

Updated: Apr 26, 2020
  • Author: Willis Hughes Lyford, MD; Chief Editor: William D James, MD  more...
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Guidelines Summary

Strict sun protection is the cornerstone of all melasma treatment plans. Success or failure often relys on patient compliance with recommendations for sun avoidance.

Management of melasma is challenging and treatment is often long-term, with potential for relapse or worsening of disease as a result of external factors.

Be aware of conditions or medications that may induce or exacerbate melasma, including medications the patient may be using for this purpose. [44]

The use of regular broad-spectrum and physical blocker sunscreens is effective for prevention of melasma and enhances the efficacy of therapies used in treatment.

Camouflage makeup can be an effective tool for managing melasma.

Hydroquinone, a tyrosinase inhibitor, is a safe and effective tool for treating disorders of hyperpigmentation. A combination hydroquinone, retinoid, and topical corticosteroid is frequently very effective treatment for melasma when used appropriately.

Tretinoin is a second-line topical agent for melasma. It may be effective but has the potential to cause skin irritation and often requires months of treatment before benefit is realized.

Tranexamic acid is an effective oral therapy for melasma that offers modest benefit with minimal adverse effects and is safe for use as long as patients are appropriately screened for risk factors prior to starting therapy.

Glycolic acid peels may be the most efficacious peeling agent for melasma, but they should be used with caution.

Q-switched ruby and erbium:yttrium-aluminum-garnet lasers are known to worsen melasma.

Fractional resurfacing laser is approved by the US Food and Drug Administration for melasma and has been shown to afford some benefit in a subset of patients. [45]