GUIDELINES IN DERMATOLOGY

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MELASMA

Arzu Kılıç1
Jale Aylin Akdaşli2

1Balıkesir University, Faculty of Medicine, Department of Dermatology, Balıkesir, Türkiye
2Balıkesir University, Faculty of Medicine, Department of Dermatology, Balıkesir, Türkiye

Kılıç A, Akdaşli JA. Melasma. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.139-151.

ABSTRACT

Melasma is a commonly seen chronic skin disorder of pigmentation. Its treatment-resistant nature can be quite challenging for both the patients and the physcians. Furthermore, it shows high recurrence rates even after the treatment which significantly impacts the quality of life for the patient. Until now, there is no efficient single-drug treatment for melasma. The current treatment model consists of combination therapies with sun protection being the cornerstone of any melasma treatment plan. Topical hydroquinone, either as monotherapy or in combination with other therapeutic modalities have been established to be the gold standard. The best results have been detected with the combination treatments including topical hydroquinone, tretinoin and steroids. Agents such as topical niacinamide, kojic acid, vitamin C and tranexemic acid have been shown to be promising in their efficiency for the combination treatments with fewer irritating side effects. In refractory cases, oral tranexamic acid, laser and light treatments, peeling, microneedling and mesotherapy are adjunctive therapies with good results.

In this review, the etiology and diagnosis of melasma, the diagnostic methods, treatment steps and novel treatments for melasma are overviewed and treatment algorithm is made.

Keywords: Melasma; Hydroquinone; Tranexamic acid; Peeling; Laser; Mesotherapy; Microneedling

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