OBJECTIVE/AIM: To examine approaches to therapy for melasma in Latin Americans and to propose treatment algorithms for patients with mild, moderate and severe melasma. BACKGROUND: Melasma is prevalent in up to 10% of the Latin American population. It is found in all racial groups and is more common in subjects with darker skin phototypes. A number of topical treatments and procedures have been used for melasma. Topical treatments containing hydroquinone are the most popular. Care must be taken when treating melasma to avoid inducing post-inflammatory hyperpigmentation and ochronosis. Determination of the severity of melasma (using the Melasma Area Severity Index and/or Physician's Global Assessment) and choice of the most effective and suitable treatment and/or procedure for individual patients is therefore essential. Sun protection is mandatory for all melasma patients. METHODS: Thirty-one clinical studies of topical treatments, chemical peels and laser and other therapies used for treating melasma were assessed for the level and quality of clinical evidence, by the Latin American Pigmentary Disorders Academy. The results of this analysis were combined with differential diagnosis guidelines and methods for assessing treatment success to establish algorithms for treating mild and moderate-to-severe melasma. RESULTS: The most appropriate first-line treatment for mild melasma is hydroquinone 4%, triple combination cream containing hydroquinone 4%, tretinoin 0.05% and fluocinolone acetate 0.01%, double combination (e.g. 4% hydroquinone and 0.1% tretinoin) or non-phenolic therapy where there is an allergy to compounds. In moderate-to-severe melasma, triple combination cream is the recommended first-line treatment. Second-line treatment is double combination or hydroquinone 4% where triple therapy is not available or if allergic to compounds. Sun avoidance measures and broad spectrum sunscreens with high SPF are fundamental for the successful management of the disease.
OBJECTIVE/AIM: To examine approaches to therapy for melasma in Latin Americans and to propose treatment algorithms for patients with mild, moderate and severe melasma. BACKGROUND: Melasma is prevalent in up to 10% of the Latin American population. It is found in all racial groups and is more common in subjects with darker skin phototypes. A number of topical treatments and procedures have been used for melasma. Topical treatments containing hydroquinone are the most popular. Care must be taken when treating melasma to avoid inducing post-inflammatory hyperpigmentation and ochronosis. Determination of the severity of melasma (using the Melasma Area Severity Index and/or Physician's Global Assessment) and choice of the most effective and suitable treatment and/or procedure for individual patients is therefore essential. Sun protection is mandatory for all melasma patients. METHODS: Thirty-one clinical studies of topical treatments, chemical peels and laser and other therapies used for treating melasma were assessed for the level and quality of clinical evidence, by the Latin American Pigmentary Disorders Academy. The results of this analysis were combined with differential diagnosis guidelines and methods for assessing treatment success to establish algorithms for treating mild and moderate-to-severe melasma. RESULTS: The most appropriate first-line treatment for mild melasma is hydroquinone 4%, triple combination cream containing hydroquinone 4%, tretinoin 0.05% and fluocinolone acetate 0.01%, double combination (e.g. 4% hydroquinone and 0.1% tretinoin) or non-phenolic therapy where there is an allergy to compounds. In moderate-to-severe melasma, triple combination cream is the recommended first-line treatment. Second-line treatment is double combination or hydroquinone 4% where triple therapy is not available or if allergic to compounds. Sun avoidance measures and broad spectrum sunscreens with high SPF are fundamental for the successful management of the disease.
Authors: Sérgio Schalka; Denise Steiner; Flávia Naranjo Ravelli; Tatiana Steiner; Aripuanã Cobério Terena; Carolina Reato Marçon; Eloisa Leis Ayres; Flávia Alvim Sant'anna Addor; Helio Amante Miot; Humberto Ponzio; Ida Duarte; Jane Neffá; José Antônio Jabur da Cunha; Juliana Catucci Boza; Luciana de Paula Samorano; Marcelo de Paula Corrêa; Marcus Maia; Nilton Nasser; Olga Maria Rodrigues Ribeiro Leite; Otávio Sergio Lopes; Pedro Dantas Oliveira; Renata Leal Bregunci Meyer; Tânia Cestari; Vitor Manoel Silva dos Reis; Vitória Regina Pedreira de Almeida Rego Journal: An Bras Dermatol Date: 2014 Nov-Dec Impact factor: 1.896
Authors: Daniel P Cassiano; Ana Cláudia C Espósito; Carolina N da Silva; Paula B Lima; Joana A F Dias; Karime Hassun; Luciane D B Miot; Hélio A Miot; Ediléia Bagatin Journal: Dermatol Ther (Heidelb) Date: 2022-07-29
Authors: Orlando Oliveira de Morais; Érica Freitas Lima Lemos; Márcia Carolline dos Santos Sousa; Ciro Martins Gomes; Izelda Maria Carvalho Costa; Carmen Déa Ribeiro de Paula Journal: An Bras Dermatol Date: 2013 Mar-Apr Impact factor: 1.896