Department of Dermatology, Venereology & Leprosy, Dr. Rajendra Prasad Government Medical College, Kangra, India.
Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India.
J Cosmet Dermatol. 2022 Sep;21(9):3707-3728. doi: 10.1111/jocd.15242. Epub 2022 Jul 31.
Melasma is a common malady affecting all races with a higher incidence in Hispanics, Middle Eastern, Asians, and African origin females (Fitzpatrick skin phototypes III-V). Women are affected much more often than men. Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects, and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post-inflammatory hyperpigmentation, particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA-approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma.
黄褐斑是一种常见的疾病，影响所有种族，其中西班牙裔、中东、亚洲和非洲裔女性（Fitzpatrick 皮肤光型 III-V）发病率较高。女性比男性更容易受到影响。黄褐斑仍然是导致美容发病率和社交尴尬的重要原因，影响生活质量，需要有效的和可靠的治疗。不幸的是，由于疗效有限、不良反应和治疗停止后复发，治疗仍然不尽如人意。虽然化学换肤、激光和光疗以及磨皮术可能有一定的作用，但它们的疗效证据有限，而且它们经常导致炎症后色素沉着过度，尤其是在皮肤类型较深的个体中。医学治疗仍然是黄褐斑管理的主要方法。三联疗法，氢醌 4%、维 A 酸 0.05%和氟轻松醋酸酯 0.01%（Triluma，Galderma，Ft. Worth Texas，通常会根据不同的皮质类固醇进行修改）仍然是唯一获得美国食品和药物管理局批准的黄褐斑治疗方法，也是黄金标准，因为它在不同种族中都显示出了疗效。单独使用或与其他方式联合使用口服氨甲环酸也显示出了显著的疗效。几种用作皮肤美白剂的化妆品和植物提取物已被证明是有用的。含有氧化锌、氧化铁、二氧化钛和硅酮的物理防晒霜提供了光保护和伪装效果。我们提出，多模式治疗黄褐斑是最有效的治疗方法。本综述重点介绍了黄褐斑的医学治疗方法。
