From the Guidelines
Melasma management in skin of color should prioritize the use of platelet-rich plasma (PRP) as an effective treatment option, given its significant improvement in melanin levels and patient satisfaction, as demonstrated in recent studies 1.
Key Considerations
- Sun protection with broad-spectrum SPF 50+ sunscreen applied every 2-3 hours when outdoors, along with wide-brimmed hats and sun-avoidant behavior, remains a crucial first-line treatment.
- Topical treatments such as hydroquinone 4%, triple combination creams, and non-hydroquinone agents like tranexamic acid, azelaic acid, and kojic acid can be used, but PRP has shown to be significantly better than intradermal tranexamic acid in managing melasma 1.
- Chemical peels and laser treatments can be used as adjunctive treatments but must be approached cautiously in darker skin to avoid post-inflammatory hyperpigmentation.
Treatment Approach
- PRP injection significantly improved melasma within 6 weeks of treatment in terms of mMASI scores, with a mean MASI reduction from 10 and a melanin index (MI) reduction from 256.5 1.
- Patient satisfaction improved significantly in the PRP group, with a mean reduction in MASI, MI, and PSS after treatment found to be significant (p < 0.05) 1.
- The use of PRP as an adjuvant therapy or standalone treatment for melasma can induce collagen synthesis, thus improving the quality and texture of the skin 1.
Recommendations
- PRP should be considered as a primary treatment option for melasma in skin of color, given its efficacy and safety profile, as demonstrated in recent studies 1.
- A comprehensive approach combining sun protection, topical treatments, and sometimes procedures should be tailored to each patient's needs and skin type.
- Regular follow-up and maintenance treatments are necessary to prevent rebound hyperpigmentation and ensure long-term improvement in melasma.
From the FDA Drug Label
HYDROQUINONE USP, 4% SKIN BLEACHING CREAM is indicated for the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines, and other unwanted areas of melanin hyperpigmentation. For melasma management in skin of colour, hydroquinone 4% can be used as it is indicated for the gradual bleaching of hyperpigmented skin conditions such as melasma 2.
- Key points:
- Hydroquinone is used for bleaching hyperpigmented skin conditions
- It is specifically indicated for melasma
- Sunlight or ultraviolet light exposure will cause repigmentation of bleached areas 2
From the Research
Melasma Management in Skin of Colour
- Melasma is a chronic hypermelanosis of the skin that affects approximately 1% of the global population, predominantly affects women, and is more prevalent in skin of color 3.
- The condition can be challenging to treat, particularly in patients with skin of color, and requires a flexible and focused treatment algorithm that reflects both treatment and maintenance periods 3.
Treatment Options
- Topical treatments for melasma include hydroquinone, tretinoin, corticosteroids, and triple combination creams, which have shown varying efficacies in treating the condition 4.
- Azelaic acid has also been found to be effective in reducing melasma, with one study suggesting that 20% azelaic acid cream may be more effective than hydroquinone 4% in reducing mild melasma 5.
- Combination therapy of topical retinoids, corticosteroids, and hydroquinone has been effective in treating melasma, but long-term use is limited by corticosteroid atrophy and exogenous ochronosis 6.
- Oral therapies, such as tranexamic acid, Polypodium leucotomos, and glutathione, have also shown promise in treating melasma 7.
Treatment Considerations
- Treatment of melasma in skin of color requires careful consideration of the potential for adverse side effects, such as skin irritation, dryness, burning, erythema, and post-inflammatory hyperpigmentation 4.
- Combination therapies within or across treatment modalities generally result in better efficacies than monotherapies 7.
- A steering committee consensus on clinical best practices for the treatment of melasma in skin of color is essential to standardize care and ensure the best available evidence is used to guide treatment decisions 3.