From the Research
Introduction to Melasma Treatment
Melasma, also known as chloasma, is a chronic skin condition characterized by the overproduction of melanin in areas exposed to ultraviolet radiation. The treatment of melasma is long-term and complicated, often involving a combination of topical agents, procedural therapies, and systemic treatments.
Topical Treatments
Topical treatments for melasma include:
- Hydroquinone, which is the most common treatment for melasma 1, 2
- Tretinoin, a retinoic acid derivative that helps to reduce melanin production 3, 1
- Corticosteroids, which can be used in combination with hydroquinone and tretinoin to increase efficacy 3, 4
- Azelaic acid, a non-phenolic bleaching agent that can be used as an alternative to hydroquinone 1, 2
- Triple combination creams, which typically contain hydroquinone, tretinoin, and fluocinolone acetonide, and are considered the gold standard for melasma treatment 4
Procedural Therapies
Procedural therapies for melasma include:
- Chemical peels, which can be used to remove the top layers of skin and reduce melanin production 3, 1, 2
- Microneedling, a minimally invasive procedure that uses tiny needles to stimulate collagen production and improve skin texture 3
- Laser and light treatments, which can be used to target and reduce melanin production in the skin 3, 1, 2
- Mesotherapy, a procedure that involves injecting a solution into the skin to reduce melanin production and improve skin texture 5
Systemic Treatments
Systemic treatments for melasma include:
- Tranexamic acid, an oral medication that has been shown to be effective in reducing melanin production and improving skin hyperpigmentation 3, 4
- Polypodium leucotomos, an oral supplement that has been shown to have antioxidant and anti-inflammatory properties and may be beneficial in reducing melanin production 3
- Glutathione, an oral supplement that has been shown to have antioxidant properties and may be beneficial in reducing melanin production 3
Treatment Approach
A multimodality approach to the treatment of melasma is often the most effective, combining topical treatments, procedural therapies, and systemic treatments to achieve optimal results 5, 3, 4. It is also important to eliminate risk factors, such as ultraviolet radiation, and use strict photoprotection to prevent further skin damage and hyperpigmentation 5, 3, 4.
Caveats and Considerations
When treating melasma, it is important to consider the potential risks and side effects of each treatment, including post-inflammatory hyperpigmentation, skin irritation, and ochronosis 4, 1, 2. It is also important to have realistic expectations and to be patient, as the treatment of melasma can be long-term and challenging. A thorough understanding of the condition and its treatment options, as well as good communication and a strong relationship with the patient, are essential for achieving good adherence and compliance with treatment 5.