Gurpreet Singh Jutley1, Ratna Rajaratnam2, James Halpern3, Asad Salim4, Charis Emmett5. 1. Department of Dermatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. Electronic address: jutley@doctors.org.uk. 2. Department of Dermatology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 3. Department of Dermatology, Walsall Healthcare National Health Service (NHS) Trust, Walsall, United Kingdom. 4. Department of Dermatology, Countess of Chester NHS Trust, Chester, United Kingdom. 5. Department of Mathematics, Keele University, Stoke on Trent, United Kingdom.
Abstract
BACKGROUND: Multiple treatments exist for melasma; they are often substandard and associated with side effects. OBJECTIVES: We sought to assess the effectiveness of interventions used in the management of all types of melasma. METHODS: We undertook a systematic review using the methodology of the Cochrane Collaboration. RESULTS: We included 20 studies with a total of 2125 participants covering 23 different treatments. A meta-analysis was not possible because of the heterogeneity of treatments. Triple-combination cream (hydroquinone, tretinoin, and fluocinolone acetonide) was more effective at lightening melasma than hydroquinone alone (relative risk 1.58, 95% confidence interval 1.26-1.97) or any of the agents in a dual-combination cream. Azelaic acid (20%) was significantly more effective than 2% hydroquinone (relative risk 1.25, 95% confidence interval 1.06-1.48) at lightening melasma. In 2 studies where tretinoin was compared with placebo, objective measures demonstrated significant reductions in the severity. However, only in 1 study did participants rate a significant improvement (relative risk 13, 95% confidence interval 1.88-89.74). LIMITATIONS: There was poor methodology, a lack of standardized outcome assessments, and short duration of studies. CONCLUSIONS: The current limited evidence supports the efficacy of multiple interventions. Randomized controlled trials on well-defined participants with long-term outcomes are needed.
BACKGROUND: Multiple treatments exist for melasma; they are often substandard and associated with side effects. OBJECTIVES: We sought to assess the effectiveness of interventions used in the management of all types of melasma. METHODS: We undertook a systematic review using the methodology of the Cochrane Collaboration. RESULTS: We included 20 studies with a total of 2125 participants covering 23 different treatments. A meta-analysis was not possible because of the heterogeneity of treatments. Triple-combination cream (hydroquinone, tretinoin, and fluocinolone acetonide) was more effective at lightening melasma than hydroquinone alone (relative risk 1.58, 95% confidence interval 1.26-1.97) or any of the agents in a dual-combination cream. Azelaic acid (20%) was significantly more effective than 2% hydroquinone (relative risk 1.25, 95% confidence interval 1.06-1.48) at lightening melasma. In 2 studies where tretinoin was compared with placebo, objective measures demonstrated significant reductions in the severity. However, only in 1 study did participants rate a significant improvement (relative risk 13, 95% confidence interval 1.88-89.74). LIMITATIONS: There was poor methodology, a lack of standardized outcome assessments, and short duration of studies. CONCLUSIONS: The current limited evidence supports the efficacy of multiple interventions. Randomized controlled trials on well-defined participants with long-term outcomes are needed.