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Review
. 2022 May;15(5):19-28.

Topical Treatments for Melasma and Their Mechanism of Action

Valeria González-Molina  1 , Alicia Martí-Pineda  2 , Noelani González  3
Affiliations
Review

Topical Treatments for Melasma and Their Mechanism of Action

Valeria González-Molina et al. J Clin Aesthet Dermatol. 2022 May.

Abstract

Objective: We conducted a review of topical agents currently used in melasma, discussing their mechanism of action, efficacy, safety, and tolerability, with an update on newer treatments.

Methods: A systematic review from PubMed database was performed, using PRISMA guidelines. The search was limited to English and Spanish studies that were double or single blinded, prospective, controlled or randomized clinical trials, reviews of literature, and meta-analysis studies.

Results: 348 studies were analyzed; 80 papers met inclusion criteria. Triple combination (TC) therapy and hydroquinone (HQ) are still the most well-studied agents with strong evidence-based recommendation. TC therapy remains the gold standard of care based on efficacy and patient tolerability. Evidence has shown ascorbic acid, azelaic acid, glycolic acid, kojic acid, salicylic acid, and niacinamide to be effective as adjuvant therapies with minimal side effects. Tranexamic acid (TA) and cysteamine have become recent agents of interest due to their good tolerability, however more trials and studies are warranted. Less evidence exists for other topical agents, such as linoleic acid, mulberry extract oil, rucinol, 2% undecylenoyl phenylalanine, and epidermal growth factors agents.

Limitations: Some studies discussed represented a low sample size, and there is an overall lack of recent studies with larger populations and long-term follow up.

Conclusions: TC therapy continues to be the gold standard of care. Topical cysteamine and TA are newer options that can be incorporated as adjuvant and maintenance treatments into a patient's regimen. Cysteamine and topical TA have no known severe adverse effects. Evidence comparing other topical adjuvant treatments to HQ, maintains HQ as the gold standard of care.

Keywords: chloasma; depigmentation; depigmented agents; melanosis; melasma; peels; skin-lightening agents; therapy; topicals.

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Conflict of interest statement

DISCLOSURES: The authors report no conflicts of interest relavant to the content of this article.

Figures

FIGURE 1.
FIGURE 1.
Flow diagram of article selection
FIGURE 2.
FIGURE 2.
Mechanism of action in the melanogenesis pathway of some topical agents used for melasma
FIGURE 3.
FIGURE 3.
Mechanisms of action and side effects of some topical agents used in melasma
See this image and copyright information in PMC

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