Melasma

Effectiveness and safety of acupuncture for melasma: A meta-analysis of randomized controlled trials.

Su J, Quan T, Liao T, Luo Y, Fan X, Pan M · Explore (New York, N.Y.) · 2025 · n=1644

Treating melasma remains challenging. We conducted a meta-analysis to assess the effectiveness and safety of acupuncture as a treatment option. We searched three English and four Chinese databases up to January 2, 2024. The primary outcome was the total effective rate, while secondary outcomes included skin lesion area and color scores, total lesion score, and adverse effects. Study quality was assessed using the risk of bias tool, and data were analyzed with Review Manager 5.4. The GRADE approach evaluated evidence certainty. This study included 22 studies with 1644 participants. Findings indicate that acupuncture significantly outperforms Western medicine and other treatments (risk ratio [RR] = 1.21, 95 % confidence interval [CI] (1.18, 1.30), P < 0.00001, I² = 34 %). Acupuncture effectively reduces the area of skin lesions (mean difference [MD] = -0.35, 95 % CI (-0.52, -0.19), P < 0.0001, I² = 93 %), lightens color (MD = -0.45, 95 % CI (-0.58, -0.31), P < 0.0000

The efficacy and safety of microneedling with topical tranexamic acid for melasma treatment: A systematic review and meta-analysis.

Feng X, Su H, Xie J · Journal of cosmetic dermatology · 2024

Microneedling with topical tranexamic acid (TXA) is a novel treatment option for melasma; however, the efficacy and safety of this combined administration therapy is in controversial. This study is conducted to address this issue of this technique in melasma. An extensive literature review was performed to identify relevant trials, including randomized split-face studies, randomized controlled trials and prospective non-randomized split-face studies, comparing microneedling plus topical TXA to routine treatments or placebo. The primary outcomes were changes of the Melasma Area Severity Index (MASI)/modified MASI (mMASI)/hemi MASI between before and after treatment, as well as the changes between a particular treatment and microneedling plus TXA. The mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the reduction of melasma severity scores from baseline to each time point. In contrast, the standard mean differences (SMDs) and 95% CIs were calculated for the

The Impact of Antioxidants on Vitiligo and Melasma: A Scoping Review and Meta-Analysis.

Speeckaert R, Bulat V, Speeckaert MM, van Geel N · Antioxidants (Basel, Switzerland) · 2023

Reactive oxygen species (ROS) generated during melanogenesis make melanocytes particularly vulnerable to oxidative stress, influencing their survival and melanin synthesis. Oxidative stress, significantly present in vitiligo and recently also detected in melasma, triggers inflammatory cascades and melanogenesis, making antioxidants a promising therapeutic avenue. A systematic search was conducted on Embase and Pubmed to study the efficacy of antioxidants for treating vitiligo and/or melasma. Meta-analysis was performed to assess the difference in Melasma Severity Index (MASI) scores between baseline and follow-up. Various antioxidants like polypodium leucotomos, ginkgo biloba, catalase/superoxide dismutase, and vitamin E have potential in vitiligo. For melasma, vitamin C, silymarin, and niacinamide were among those showing promise in reducing pigmentation, with vitamin C displaying significant effects in meta-analysis. Different antioxidants improve both vitiligo and melasma, with an i

Role of Antioxidants in Melasma: A Systematic Review.

Sarkar R, Sahu A · Indian journal of dermatology · 2025

Melasma is a common skin disorder characterized by facial hyperpigmentation, often aggravated by sun exposure. Antioxidants are being studied as a treatment option for their potential to reduce oxidative stress and improve skin pigmentation. A comprehensive literature search was conducted in PubMed for articles published over the past decade, up to January 31, 2024, on the use of antioxidants in melasma treatment. The systematic review, conducted by two independent investigators, included 30 studies on antioxidants in melasma, covering vitamin C, cysteamine, silymarin, PLE, tomato extract/lycopene, zinc sulfate, melatonin, and other antioxidants. Findings indicated that combining vitamin C with physical therapies, such as peels and lasers, yielded better results. Cysteamine, a naturally occurring aminothiol, showed efficacy comparable to hydroquinone with fewer side effects. Silymarin was effective in reducing melasma severity with minimal adverse effects. PLE showed mixed results but

Probiotics, Prebiotics, and Synbiotics as Oral Supplements for Skin Health, Function, and Disease Throughout the Life Course: A Scoping Review.

Hillier RA, Gibson R, Maruthappu T, Whelan K, Prpa EJ, Neill HR · Nutrition reviews · 2025

In this review we sought to map the body of published literature on the role of oral probiotics, prebiotics, and synbiotics in maintaining and optimizing skin health and function and preventing and managing skin conditions throughout the life course. Globally, the burden of skin diseases is considerable. Diet is a modifiable risk factor for many dermatological conditions, and one mechanism by which nutrition influences skin health is through the gut microbiome. Oral probiotics, prebiotics, and synbiotics have the potential to improve skin health, delay skin aging, and successfully treat dermatological diseases. We developed a scoping review protocol in accordance with the Johanna Briggs Institute methodology. Six online databases were systematically searched for peer-reviewed literature, and non-peer-reviewed sources were also considered. All records were screened independently by 2 reviewers using predefined eligibility criteria. A total of 516 studies were included in the scoping rev

Efficacy of topical vitamin C in melasma and photoaging: A systematic review.

Correia G, Magina S · Journal of cosmetic dermatology · 2023 · n=139

Vitamin C is a micronutrient present in high concentrations in normal skin and a highly prescribed cosmeceutical, well known for protecting against ultraviolet-induced pigmentation and regulating collagen production. However, there is a lack of studies evaluating the efficacy of topical vitamin C in photoaging and melasma, with this systematic review being the first to assess the existing evidence. This systematic review aims to assess whether topical vitamin C could be effective in reversing photoaging signs and treating melasma. Prospective, randomized controlled trials assessing protocols with topically applied vitamin C in patients with melasma or photodamage were searched in Medline, CENTRAL, and Scopus databases until the 12th of May 2022. Risk of bias was conducted in accordance with Cochrane Collaboration's tool for assessing the risk of bias in randomized trials, using RevMan 5.0. Seven publications were included, with 139 volunteers in total. Studies that evaluated the top

Effect of a New Skin-Lightening Cosmetic Containing Cordyceps Extract in the Treatment of Melasma: A Clinical Trial.

Shen S, Yao H, Zhu Y, Xiang W · Journal of cosmetic dermatology · 2025

Cordyceps is a valuable Chinese herbal medicine known for its various components with antioxidant properties, which may theoretically improve melasma. This study aimed to evaluate the efficacy of a new skin-lightening cosmetic containing Cordyceps extract (referred to as Cordyceps essence) in treating female patients with melasma. Sixty-two women with melasma were enrolled and randomly assigned to two groups for 12 weeks of treatment. Group A received oral tranexamic acid (TXA) combined with topical hydroquinone cream, while Group B received oral TXA combined with topical Cordyceps essence. Changes in the Melasma Area and Severity Index (MASI), melanin index (MI), and erythema index (EI) were monitored and assessed before and after treatment. Patient-reported satisfaction and adverse events were also recorded. Additionally, a metabolomic analysis was conducted on 15 randomly selected patients from Group B. After 12 weeks of treatment, intra-group comparisons revealed th

The Efficacy of Topical Cosmetic Containing Alpha-Arbutin 5% and Kojic Acid 2% Compared With Triple Combination Cream for the Treatment of Melasma: A Split-Face, Evaluator-Blinded Randomized Pilot Study.

Tantanasrigul P, Sripha A, Chongmelaxme B · Journal of cosmetic dermatology · 2025 · n=30

While the gold standard treatment for melasma is triple combination cream (TCC), arbutin and kojic acid demonstrate their benefits and may be used as an alternative. To investigate the efficacy of cream containing alpha-arbutin 5% and kojic acid 2% (AAK) compared with TCC for melasma treatment. A split-faced, randomized study was conducted among 30 participants with melasma, and all were randomized to receive AAK or TCC on each side of their face for 12-week along with 4-week follow-up period. The melanin index (MI), modified Melasma Area Severity Index (mMASI), and physician global assessment (PGA) scores were used to measure the effectiveness of interventions. Recurrence of melasma after treatment discontinuation was evaluated by MI and mMASI. Patient satisfactions and adverse effects were also evaluated. In the analysis, the mean difference (MD) was used for MI and mMASI, while Wilcoxon signed-rank test was for the PGA scores, adverse effects, and patient satisfaction. The MD of

Evaluation of the Efficacy of a Serum Containing Niacinamide, Tranexamic Acid, Vitamin C, and Hydroxy Acid Compared to 4% Hydroquinone in the Management of Melasma.

Rocio J, Pittet JC, Sachdev M, Kovylkina N, Deloche Bensmaine C, Passeron T · Journal of cosmetic dermatology · 2025

Melasma is a common skin condition that remains challenging to treat. Hydroquinone at 4% (HQ4%) is a frequently prescribed depigmenting compound that has been associated with potential side effects. This study assessed the benefit in melasma of an anti-hyperpigmentation serum (Serum B3 containing 5% niacinamide, 1% tranexamic acid, 0.2% of a stabilized form of vitamin C, and different hydroxy acids) compared to HQ4%. In a single-site, investigator-blind, randomized study, 60 females aged between 20 and 50 years with facial melasma received Serum B3 for 5 months (Group 1) or HQ4% for 3 months followed by Serum B3 for an additional2 months (Group 2). Endpoints were Melasma Area and Severity Index (MASI), modified MASI (mMASI), Investigational Global Assessment, erythema, clinical cutaneous parameters, and safety. Subjects assessed quality of life (QoL) and cosmetic acceptability. Confocal reflecting microscopy was performed. A significant (p < 0.0

Menopause and Common Dermatoses: A Systematic Review.

Roster K, Fleshner L, Karatas TB, Ecanow A, Sayegh A, Farabi B · American journal of clinical dermatology · 2026

Menopause is a universal physiological transition, marked by a decline in estrogen, which has important effects on skin and mucosal health. The impact of menopause and menopausal hormone therapy (MHT) on chronic dermatoses remains incompletely defined. The aim was to investigate the relationship between menopause, MHT, and common dermatological conditions. PubMed, Embase, and Web of Science were searched from inception to September 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies evaluated menopause or MHT in relation to alopecia, psoriasis, acne, rosacea, melasma, and hidradenitis suppurativa (HS). Investigational cohorts largely consisted of menopausal women, although participant characteristics varied. Data on study design, population, hormonal status, and dermatological outcomes were extracted and synthesized. A total of 40 studies met inclusion criteria. Alopecia, particularly frontal fibrosing alop

Efficacy of formulations for treating hyperpigmentation: a systematic review and meta-analysis.

Kumari B, Dixit AK · Archives of dermatological research · 2025 · n=337

Hyperpigmentation is a commonly occurring skin problem, it affects people's quality of life by causing anxiety and depression in them. This systematic review aims to critically evaluate the evidence of the effectiveness of formulations utilized in clinical trials for treating hyperpigmentation (melasma and photoaging). A comprehensive search was conducted using the Scopus, PubMed, Google Scholar, and National Center for Biotechnology Information (NCBI) databases, encompassing literature available up to December 2023. Clinical trials employing various formulations to address skin hyperpigmentation effectively were included and subsequently analysed. Meta-analysis was conducted using IBM SPSS Statistics software (version 29.0.1.0 for window) guidelines. From 102 literatures, 07 clinical studies that follow the inclusion criteria were selected. A total of 337 participants underwent a clinical trial, where 198 participants received the drug and 153 received a placebo. Meta-analysis of 07 c

An Updated Review of Topical Tretinoin in Dermatology: From Acne and Photoaging to Skin Cancer.

Balado-Simó P, Morgado-Carrasco D, Gómez-Armayones S, López-Ferrer A, Barco D, Ferrándiz-Pulido C · Journal of clinical medicine · 2025

Topical tretinoin (all-trans-retinoic acid) is a first-generation vitamin A derivative with well-established efficacy in acne vulgaris and photoaging. Owing to its pleiotropic effects on epidermal differentiation, collagen synthesis, and skin pigmentation, numerous off-label uses have been proposed across dermatology. This narrative review summarizes current evidence on the efficacy and safety of topical tretinoin for multiple dermatological conditions, based on studies published between January 2000 and July 2025. Robust data from randomized clinical trials (RCTs) and systematic reviews support its benefit in acne and photoaging, whereas smaller RCTs and prospective studies indicate potential efficacy for melasma, postinflammatory hyperpigmentation, striae distensae, flat warts, alopecia areata, androgenetic alopecia, hypertrophic scars and keloids, and actinic keratosis and as pretreatment before chemical peels or laser resurfacing. However, high-quality, adequately powered trials wi

Melasma: Diagnosis and treatment

American Academy of Dermatology (AAD)

This AAD page provides an overview of melasma, including its causes, diagnosis, and various treatment options like topical creams, procedures, and sun protection, aimed at public understanding.

Effectiveness of Curcuma Xanthorriza Roxb. 10% Cream in Reducing Melasma Area and Severity Index (MASI) Scores and Improvement of Skin Brightness in Epidermal Type Melasma

n=15 · NCT06153134 · UNKNOWN · UNKNOWN

Melasma is an acquired hyperpigmentation disorder with a multifactorial etiology and complex pathogenesis that can significantly diminish the quality of life for affected patients. As of now, melasma therapy remains challenging due to its high recurrence rate and the common occurrence of treatment-related side effects. The use of depigmentation agents is a crucial component in managing melasma. Hydroquinone stands as the first-line depigmentation agent for melasma; however, its use often leads to adverse effects. Therefore, alternative depigmentation agents are needed. Curcuma xanthorriza Roxb., a native plant of Indonesia, operates by inhibiting the tyrosinase enzyme, reducing MITF transcription, and inhibiting α-MSH. Despite these potential benefits, Curcuma xanthorriza Roxb. has not been utilized as a depigmentation agent. Research on the effectiveness of Curcuma xanthorriza Roxb. as a depigmentation agent in melasma treatment has not been conducted. Therefore, it is essential to conduct research to determine the effectiveness of a 10% Curcuma xanthorrhiza Roxb. cream in reducing MASI scores and enhancing skin brightness in epidermal-type melasma.

Topical 20% Azelaic Acid Versus 4% Hydroquinone in Epidermal Melasma: A Randomized Controlled Trial

n=146 · NCT07327983 · COMPLETED · COMPLETED

Melasma is a common skin condition that causes dark patches on the face and can significantly affect quality of life. This study compared two commonly used topical treatments, 20% azelaic acid and 4% hydroquinone, in adults with epidermal melasma. Participants with epidermal melasma were randomly assigned to receive either azelaic acid 20% or hydroquinone 4% for a period of 12 weeks. The severity of melasma was assessed at baseline and monthly using the Melasma Area and Severity Index (MASI) score. Side effects such as irritation, redness, burning, itching, and dryness were also monitored throughout the study. The purpose of this study was to compare the effectiveness and safety of azelaic acid and hydroquinone in reducing melasma severity and to determine whether azelaic acid can be used as a safe alternative to hydroquinone.

Development Of Adipose-Derived Mesenchymal Stem Cells Secretome (ADMSCS) Based Products From Stem Cell Conditioned Medium For Melasma Therapy

n=34 · NCT07137130 · NOT_YET_RECRUITING · NOT_YET_RECRUITING

A therapeutic modality currently being developed for melasma is secretome. Secretome is a bioactive molecule secreted by mesenchymal stem cells in a conditioned medium containing a large number of growth factors, cytokines, various macromolecules, and extracellular vesicles, including microvesicles and exosomes, that can stimulate various biological reactions, particularly in modulating new tissue formation. Secretome can provide a depigmenting effect by increasing the proliferation and migration of epidermal keratinocytes, which contain melanin pigment, in line with increased fibroblast synthesis. Secretomes contain various cytokines and growth factors, one of which is transforming growth factor (TGF)-β. TGF-β is primarily secreted by fibroblasts (FB) and, to a lesser extent, by keratinocytes, and plays a crucial role in regulating melanocyte function. TGF-β has been reported to inhibit cAMP/protein kinase A signaling and induce GLI2, which then suppresses microphthalmia-associated transcription factor (MITF), a central transcription factor in melanogenesis. A study by Moon et al. in Korea examined TGF-β3. Moon et al. examined the effects of TGF-β3 on melanogenesis in human melanocytes co-cultured with skin cells irradiated with ultraviolet (UV) light, and in UV-irradiated human skin. The results showed that UVB irradiation or stem cell factor (SCF)/endothelin-1 (ET-1) increased melanogenesis. TGF-β3 effectively inhibited melanin accumulation and tyrosinase activity by downregulating the extracellular signal-regulated kinase (ERK)/microphthalmia-associated transcription factor (MITF) pathway. TGF-β3 increased the expression of keratinocyte differentiation markers. Mechanistically, TGF-β3 inhibits melanogenesis by inhibiting MITF expression, which is regulated by ERK. TGF-β1 reduces MITF but at the risk of inducing skin fibrosis. However, in the study by Moon et al., the aforementioned TGF Beta 1 function was not found in TGF-β3. Furthermore, TGF-β3 restored skin differentiation function in UV-irradiated keratinocytes. To date, there have been no clinical trials comparing intradermal injection of concentrated secretome with intradermal injection of concentrated secretome with the addition of TGF-β3 as a melasma therapy in Indonesia, thus encouraging researchers to conduct further research.