Systematic review of randomized controlled trials on interventions for melasma: An abridged Cochrane review - 16/01/14
, Ratna Rajaratnam, BSc a, James Halpern, MRCP b, Asad Salim, FRCP c, Charis Emmett, BSc dAbstract |
Background |
Multiple treatments exist for melasma; they are often substandard and associated with side effects.
Objectives |
We sought to assess the effectiveness of interventions used in the management of all types of melasma.
Methods |
We undertook a systematic review using the methodology of the Cochrane Collaboration.
Results |
We included 20 studies with a total of 2125 participants covering 23 different treatments. A meta-analysis was not possible because of the heterogeneity of treatments. Triple-combination cream (hydroquinone, tretinoin, and fluocinolone acetonide) was more effective at lightening melasma than hydroquinone alone (relative risk 1.58, 95% confidence interval 1.26-1.97) or any of the agents in a dual-combination cream. Azelaic acid (20%) was significantly more effective than 2% hydroquinone (relative risk 1.25, 95% confidence interval 1.06-1.48) at lightening melasma. In 2 studies where tretinoin was compared with placebo, objective measures demonstrated significant reductions in the severity. However, only in 1 study did participants rate a significant improvement (relative risk 13, 95% confidence interval 1.88-89.74).
Limitations |
There was poor methodology, a lack of standardized outcome assessments, and short duration of studies.
Conclusions |
The current limited evidence supports the efficacy of multiple interventions. Randomized controlled trials on well-defined participants with long-term outcomes are needed.
Le texte complet de cet article est disponible en PDF.Key words : ascorbic acid, azelaic acid, chloasma, glycolic acid, hydroquinone, melasma, pigment, tretinoin, triple combination, vitamin C
Plan
| The Cochrane Review is published with the support of the CRG. |
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| Conflicts of interest: None declared. |
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| This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 7, DOI:10.1002/14651858.CD003583 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. |
Vol 70 - N° 2
P. 369-373 - février 2014 Retour au numéro
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