Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov-Dec;62(6):558-577.
doi: 10.4103/ijd.IJD_489_17.

Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Rashmi Sarkar  1 , Narendra Gokhale  2 , Kiran Godse  3 , Pallavi Ailawadi  4 , Latika Arya  5 , Nilendu Sarma  6 , R G Torsekar  7 , V K Somani  8 , Pooja Arora  9 , Imran Majid  10 , G Ravichandran  11 , Mohan Singh  12 , Sanjeev Aurangabadkar  13 , Shehnaz Arsiwala  14 , Sidharth Sonthalia  15 , T Salim  16 , Swapnil Shah  17
Affiliations

Medical Management of Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group

Rashmi Sarkar et al. Indian J Dermatol. 2017 Nov-Dec.

Abstract

Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

Keywords: Expert group; medical treatment; melasma.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest. What is new? Although topical therapy with hydroquinone and triple combination therapy leads the list in treatment of melasma, a careful watch for side effects of topical corticosteroids must be done. Mometasone or fluticasone containing creams should be totally discouraged.A large number of newer botanical agents offer a suitable alternative and should be used for maintaining lightening of melasma.Sunscreens containing more of inorganic sunscreens especially iron oxide appear more promising.Oral agents, especially tranexamic acid has been well studied and used but does need more follow up for side effects.Treatment of medical conditions concomitantly is important.

Figures

Figure 1
Figure 1
Treatment algorithm for melasma in India, by a Consensus meeting of SPF(South Asian Pigmentary Disorders forum) with Pigmentary Disorders Society(PDS)
See this image and copyright information in PMC

References

    1. Sivayathorn A. Melasma in orientals. Clin Drug Invest. 1995;10:34–40.
    1. Sarkar R, Puri P, Jain RK, Singh A, Desai A. Melasma in men: A clinical, aetiological and histological study. J Eur Acad Dermatol Venereol. 2010;24:768–72. - PubMed
    1. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23:1254–62. - PubMed
    1. Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA, et al. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013;27:151–6. - PubMed
    1. Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzalez EA, Villemur JA, et al. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab. 1985;61:28–31. - PubMed

LinkOut - more resources