title: Advances in the treatment of melasma: a review of the recent literature.
abstract: BACKGROUND
  Melasma is an acquired pigmentary disorder classically manifesting as symmetric hyperpigmented macules and patches on the face. It most commonly affects women of reproductive age with darker skin tones but may also affect adolescents, older women, and men. Although its pathogenesis remains unclear, known risk factors include ultraviolet radiation, hormonal variations of pregnancy, thyroid disease, oral contraceptives, and antiseizure medications. Hydroquinone-containing topical agents are the current standard for melasma treatment, but concern about side effects and long-term safety has spurred efforts to develop alternative treatment options.
  
  
  OBJECTIVE
  To review recent advances in melasma treatment.
  
  
  METHODS
  MEDLINE was searched from 2006 to the present for randomized controlled trials (RCTs) of melasma treatments.
  
  
  RESULTS
  Nineteen published RCTs were found covering interventions such as topical therapies, chemical peels, and electromagnetic devices. The outcomes of the studies were summarized into tabular form for easy reference and comparison.
  
  
  CONCLUSIONS
  Although melasma is difficult to treat, novel therapeutic modalities have emerged. Further RCT need to be performed to better assess the safety and efficacy of these novel treatment modalities, especially for the long-term maintenance of melasma.
authors.affiliation: Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Katharine L
authors.initials: KL
authors.lastname: Ball Arefiev
authors.forename: Basil M
authors.initials: BM
authors.lastname: Hantash
mesh_terms: D000279:Administration, Cutaneous; D000975:Antioxidants / Q000627:therapeutic use; D044946:Biflavonoids / Q000627:therapeutic use; D002392:Catechin / Q000627:therapeutic use; D002615:Chemexfoliation; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005148:Facial Dermatoses / Q000628:therapy; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008548:Melanosis / Q000628:therapy*; D010789:Phototherapy; D044945:Proanthocyanidins / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D044946:Biflavonoids; D003879:Dermatologic Agents; D044945:Proanthocyanidins; D014815:Vitamins; C017674:procyanidin; D002392:Catechin