Melasma Treatment: An Evidence-Based Review

McKesey, Jacqueline; Tovar‐Garza, Andrea; Pandya, Amit G.

doi:10.1007/s40257-019-00488-w

Cited by 140 publications

(158 citation statements)

References 105 publications

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“…Melasma is a common focal hypermelanosis that affects photoexposed areas, especially in women of childbearing age 1 . Despite the use of broad‐spectrum sunscreen and topical bleaching agents, melasma can be recalcitrant to treatments, and relapses are common 2–4 . The chronicity of the disease and the affection of visible areas during working and competitive age inflict a major negative impact on the quality of life 5,6 …”

Section: Introductionmentioning

confidence: 99%

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Lima¹,

Dias²,

Cassiano

et al. 2020

Int J Dermatology

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Objective To assess the efficacy and safety of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Topical 5% cysteamine is an antioxidant and tyrosinase inhibitor that has been shown to be effective in the treatment of melasma. However, to date, no study has compared the performance of topical cysteamine to hydroquinone for facial melasma. Methods A quasi-randomized, multicenter, evaluator-blinded clinical trial was conducted on 40 women with facial melasma who were submitted to the nightly application of 5% cysteamine (CYS) or 4% hydroquinone (HQ) on hyperpigmented areas for 120 days. Both groups were required to use tinted sunscreen (SPF 50; PPD 19). Subjects were assessed at the inclusion and after 60 and 120 days of treatment for mMASI, MELASQoL, and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. Results The mean reduction of the mMASI scores was 24% for CYS and 41% for HQ (P = 0.015) at 60 days, and 38% for CYS and 53% for HQ (P = 0.017) at 120 days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them (P = 0.087). The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120 days (P = 0.018). Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them (P > 0.160). No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P > 0.170). Conclusion Cysteamine proved to be safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma.

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Section: Introductionmentioning

confidence: 99%

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Lima¹,

Dias²,

Cassiano

et al. 2020

Int J Dermatology

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“…Hyperpigmentation is a frequent cosmetic problem characterized by hyperpigmentation on sun‐exposed areas because of increased melanogenesis [1,2]. Although the natural sun‐induced production of melanin is desirable for its photoprotective function and the tanning effect, accumulation of abnormal amounts in specific parts of the skin resulting in darker patches is undesirable and poses an aesthetic problem [3‐5].…”

Section: Introductionmentioning

confidence: 99%

Thiamidol containing treatment regimens in facial hyperpigmentation: An international multi‐centre approach consisting of a double‐blind, controlled, split‐face study and of an open‐label, real‐world study

Philipp‐Dormston

Echagüe²,

Damonte³

et al. 2020

Intern J of Cosmetic Sci

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OBJECTIVE: Tyrosinase is the rate-limiting enzyme in melanogenesis. Thiamidol is the most potent inhibitor of human tyrosinase out of 50 000 tested compounds. In clinical studies, it was shown to improve facial hyperpigmentation, post-inflammatory hyperpigmentation and age spots significantly. To identify the optimal number of daily Thiamidol applications, we conducted a split-face study comparing the efficacy and tolerability of four-times with two-times daily application. Subsequently, we evaluated the efficacy and tolerability of a typical face care regimen containing Thiamidol in a real-world study. METHODS: The split-face study was double-blind, randomized, controlled, including two Thiamidol containing products (serum and day care SPF 30). The serum was applied twice daily on one half of the face and the day care SPF30 twice-daily on the whole face. The real-world study was open-label, observational, including three Thiamidol containing products (day care SPF 30 in the morning, serum and night care in the evening). In both studies, subjects with mild-to-moderate facial hyperpigmentation applied the products over 12 weeks. Assessments included clinical and subjective grading of hyperpigmentation, skin condition, hemi-/modified MASI, chromameter and clinical photography. RESULTS: In the split-face study (n = 34), hyperpigmentation, skin roughness and hMASI improved all significantly (P < 0.001) versus baseline, with first visible results after two weeks of twice-daily application. The four-times daily application led to significant improvement versus the two-times daily application. In the real-world study (n = 83), all evaluated parameters, including skin condition and chromametry (n = 30), improved significantly (P < 0.001) in comparison with baseline and the corresponding preceding visits. The subjects judged the cosmetic properties of the products positively. In both studies, the products were well tolerated. CONCLUSION: Four-times daily Thiamidol improves facial hyperpigmentation significantly more than two-times daily and is well tolerated by the subjects. The real-world study with a typical face care regimen containing Thiamidol shows improvement of facial hyperpigmentation and confirms tolerability. Furthermore, the data provide evidence for the suitability of this three-product Thiamidol regimen for day-today life.

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“…17 Daily treatment with mild depigmenting agents has been shown to help maintain the treatment effects of peeling. 18 It is important in this population to use a broadspectrum sunscreen with high SPF and good protection against UVA and visible light, which are known aggravating factors of pigmented lesions and melasma. 4 Recent findings revealed that UVA exposure induced CPD generation via chemoexcitation in melanocytes hours after exposure.…”

Section: Discussionmentioning

confidence: 99%

<p>A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases</p>

Piquero-Casals¹,

Granger

Piquero-Casals³

et al. 2020

CCID

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Background: Melasma is a difficult-to-treat, recurrent pigmentary disease. Combined therapy gives better, longer-lasting results. Objective: To determine the clinical effects of a treatment protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with oral antioxidant supplement and topical treatment for refractory melasma. Patients and Methods: We present four cases of patients with melasma, who, despite multiple treatments including hydroquinone, showed no improvement. We initiated a 16week protocol involving 3 in-clinic peels (4 weeks apart) and a daily home treatment. The peels contained 30% trichloroacetic acid, 2% phytic acid, 8% L-ascorbic acid, Camellia sinensis leaf extract and Vitis vinifera seed extract. The home treatment was a depigmenting serum (4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide), a specific SPF50+ sunscreen, and an oral supplement (Polypodium leucotomos; green tea extract; Vitis vinifera; vitamins C, E, and D; and carotenoids), all in the morning, and, at night, a compounded gel-cream (4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone). After 16 weeks, the gel-cream was stopped; the rest of the regimen (topical and oral) was continued for 12 further weeks. Melasma was assessed using the melasma severity scale (MSS) before starting the protocol, and at 4 and 12 weeks after the last peel. Photographs were taken before treatment and at the last evaluation. Patients indicated their satisfaction on a 5-point scale. Results: All patients had good tolerance to the procedures. Three showed an excellent (>75%) improvement and one showed a good (50-75%) improvement. All four were very satisfied. At follow-up (12 weeks after last peel), no patients had recurrence. Conclusion: This protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with an oral supplement and topical daily treatment is a viable treatment option for refractory melasma.

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Melasma Treatment: An Evidence-Based Review

Cited by 140 publications

References 105 publications

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women

Thiamidol containing treatment regimens in facial hyperpigmentation: An international multi‐centre approach consisting of a double‐blind, controlled, split‐face study and of an open‐label, real‐world study

<p>A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases</p>

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