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J Am Acad Dermatol. 2011 Oct;65(4):699-714. doi: 10.1016/j.jaad.2011.06.001.

Melasma: a comprehensive update: part II.

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Department of Dermatology at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:


Several methods of treatment are available to patients with melasma. First-line therapy usually consists of topical compounds that affect the pigment production pathway, broad-spectrum photoprotection, and camouflage. Second-line therapy often consists of the addition of chemical peels, although these must be used cautiously in patients with darker skin. Laser and light therapies represent potentially promising options for patients who are refractory to other modalities, but also carry a significant risk of worsening the disease. A thorough understanding of the risks and benefits of various therapeutic options is crucial in selecting the best treatment.

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