Journal of the American Academy of Dermatology: Published: September, 2023

Melasma is a chronic pigmentary disorder with a complex and multifactorial etiology. In this manuscript, the authors present a set of consensus-based recommendations and provide a comprehensive overview of how to manage melasma in daily clinical practice. 

TAKE-HOME MESSAGE

A consensus committee was convened to create a flexible and focused treatment algorithm for patients with skin of color with melasma.

Patients should be counseled on the use of a photoprotection and skin care regimen, including a broad-brimmed hat, sun avoidance, iron oxide–containing sunscreen, and gentle cleansers and moisturizers.

The authors recommend initial treatment with a hydroquinone-containing triple-combination cream for 2 to 6 months followed by maintenance therapy with non–hydroquinone-containing cosmeceuticals for 3 to 6 months before cycling back to the hydroquinone-containing triple-combination cream.

Optimal management of melasma in patients with skin of color includes counseling on photoprotection and gentle skin care in addition to cycling between hydroquinone and non–hydroquinone-containing topical products. Oral tranexamic acid and mechanical procedures can be added to the regimen if needed.