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Indian J Dermatol. 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.

Author information

1
Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
2
Consultant Dermatologist, Sklinic Skin Clinic, Indore, Madhya Pradesh, India.
3
Dermatology, D Y Patil Hospital, Mumbai, Maharashtra, India.
4
Dermatology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
5
Consultant Dermatologist, L A Skin and Aesthetic Clinic, New Delhi, India.
6
Dermatology, Dr B. C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India.
7
Consultant Dermatologist, Fortis Hospital, Mumbai, Maharashtra, India.
8
Consultant Dermatologist, Skintrendz, Himayat Nagar, Hyderabad, India.
9
Dermatology, Dr RML Hospital and PGIMER, New Delhi, India.
10
Dermatology, Govt Medical College, Srinagar, Jammu and Kashmir, India.
11
Senior Consultant and Coordinator, Dermatology, Apollo Hospitals, Chennai, Tamil Nadu, India.
12
Consultant Dermatologist, Mohan Skin Diseases Hospital, Phagwara, Punjab, India.
13
Consultant Dermatologist, Skin and Laser Clinic, Begumpet, Hyderabad, India.
14
Consultant Dermatologist, Saifee Hospital, Prince Aly Khan Hospital, Mumbai, Maharashtra, India.
15
Consultant Dermatologist, Skinnocence: The Skin Clinic, Gurgaon, Haryana, India.
16
Consultant Dermatologist, Cutis institute of Dermatology and Aesthetic Sciences, Calicut, Kerala, India.
17
Consultant Dermatologist, Solapur, Maharashtra, India.

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

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.

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