Table 1.
Melasma treatments, mechanisms of action, and adverse effects
| Modality | Treatment | Mechanism of action | Adverse effects (AE) |
|---|---|---|---|
| Topical | Iron oxide | Block visible and ultraviolet light | Irritation |
|
Hydroquinone (HQ), Azelaic acid, Ascorbic acid, Kojic acid |
Tyrosinase inhibitor | Irritation, exogenous ochronosis (with HQ) | |
| Tretinoin | Increased keratinocyte turnover | Irritation, redness | |
| Corticosteroids | Anti-inflammatory with non-selective inhibition of melanogenesis | Telangiectasias, epidermal atrophy, steroid-induced acne, striae, hypopigmentation | |
| Ascorbic acid | Inhibition of reactive oxygen species | No significant AE | |
| Niacinamide | Inhibition of melanosome transfer | Irritation | |
| Oral | Tranexamic acid |
Inhibits plasminogen/plasmin pathway → inhibition of melanin synthesis Decreases vascular proliferation |
Abdominal bloating, menstrual irregularities, headache, deep venous thrombosis |
| Polypodium leucotomos, Glutathione | Inhibition of reactive oxygen species | No significant AE | |
| Procedural |
Q-switch ruby laser, Q-switch Nd:Yag laser |
Melanosome destruction | Burn, post inflammatory pigment alteration (PIPA) |
| Non-ablative fractional lasers | Fractional photothermolysis leading to melanin extrusion | Burn, PIPA | |
| Chemical peels | Increased keratinocyte turnover | Burn, peeling, PIPA | |
| Microneedling | Transdermal drug delivery | Erythema, edema, tram-track marks, PIPA | |
| Intense pulsed light | Extrusion of melanosomes | Burn, PIPA | |
| Radiofrequency |
Cellular biostimulation Transdermal drug delivery |
Burn |
AE adverse effects, HQ hydroquinone, PIPA post-inflammatory pigment alteration, Nd:YAG neodymium-doped yttrium aluminum garnet