The treatment of melasma: A review of clinical trials - 09/08/11

Doi : 10.1016/j.jaad.2006.02.009

Aditya K. Gupta, MD, PhD, MBA/HCM, FRCP (C) ^a,^b,^⁎ , Melissa D. Gover, BSc ^b, Keyvan Nouri, MD ^c, Susan Taylor, MD ^d,^e
^a From the Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Sciences Center (Sunnybrook site) and the University of Toronto
^b Mediprobe Research Inc, London, Ontario, Canada
^c Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
^d Skin of Color Center, New York
^e College of Physicians and Surgeons, Columbia University, New York

Reprint requests: Aditya K. Gupta, MD, PhD, FRCP (C), 645 Windermere Rd, London, Ontario, Canada N5X 2P1.

Toronto and London, Ontario, Canada; Miami, Florida; and New York, New York

Abstract

Melasma is an irregular brown or grayish-brown facial hypermelanosis, often affecting women, especially those living in areas of intense UV radiation. The precise cause of melasma remains unknown; however, there are many possible contributing factors. Because of its dermal component and tendency to relapse, melasma is often difficult to treat. The use of broad-spectrum (UVA + UVB) sunscreen is important, as is topical hydroquinone, the most common treatment for melasma. Other lightening agents include retinoic acid (tretinoin) and azelaic acid. Combination therapies such as hydroquinone, tretinoin, and corticosteroids have been used in the treatment of melasma, and are thought to increase efficacy as compared with monotherapy. Kojic acid, isopropylcatechol, N-acetyl-4-cysteaminylphenol, and flavonoid extracts are other compounds that have been investigated for their ability to produce hypopigmentation, but their efficacy, safety, or trial design indicates that the interventions would need further study before they could be recommended. Chemical peels, laser treatments, and intense pulsed light therapy are additional therapeutic modalities that have been used to treat melasma.

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Abbreviations used : AEs, AzA, CO₂, FA, GA, HQ, IPC, IPL, MASI, MKF, PIH, RA, RCT, SWC, TCA, YAG

Plan

Combination therapy: HQ, tretinoin, and a steroid

Intense pulsed light therapy

Laser treatment

Conclusions

Funding sources: None.
Disclosure: Dr Taylor has received previous honoraria/grants or acted as a consultant or an investigator for the following companies: Allergan, Astellas, Barrier Therapeutics, Bieresdorf, Connetics, Dermik, Doak (Bradley), Galderma, Intendis, Johnson & Johnson, L’Oreal, Medicis, Palomar, Stiefel.