A Review on Topical Management of Melasma

Abstract

An upsurge in the cosmetics industry’s interest in finding new topical formulations for melasma management can be seen in recent years. We conducted a review of these agents along with their mechanism of action, safety profile, and strength of evidence. We performed a systematic review of randomized controlled trials (RCTs) on topical agents for the treatment of melasma on October 17^th, 2022, using the PRISMA guidelines. After the screening, we identified 56 original RCTs using hydroquinone (HQ) (liposomal delivered), azelaic acid, cysteamine, epidermal growth factor, lignin peroxidase, ascorbic acid, dioic acid, ellagic acid and arbutin, flutamide, triple-combination therapy, tranexamic acid (TXA), 4-n-butylresorcinol, glycolic acid, kojic acid, zinc sulfate, niacinamide, and natural agents such as Rumex occidentalis, Aloe vera, parsley, and mulberry extract were used for melasma. Triple-combination therapy continues to be the gold standard of care. Topical cysteamine and TXA are newer options that can be incorporated as adjuvant and maintenance treatment into a patient’s regimen. Newer formulations including natural agents have little or no known severe adverse effects. Evidence comparing other topical adjuvant treatments to HQ maintains its gold standard status.