Melasma is an acquired hyperpigmented skin disorder with complex etiology, and is hard to treat. External application drugs are the first-choice treatment of melasma, mainly including hydroquinone 4% cream alone or in combination with fluocinolone acetonide 0.01% cream and tretinoin 0.05% cream. At present, the efficacy and safety of topical tranexamic acid have been proved, and phenylalanine and 4-n-butylresorcinol have also shown efficacy in the treatment of melasma. In recent years, many new external application drugs have emerged gradually, including lignin peroxidase, zinc, rumex occidentalis extracts, diacetyl boldine, transforming growth factor-β1 (TFG-β1) biomimetic oligopeptide-68 and flutamide. Oral tranexamic acid can increase efficacy of the above drugs. Q-switched laser is effective for the treatment of melasma, but there is a high risk of recurrence and hyperpigmentation. Large sample size-based studies are needed to evaluate the efficacy of intense pulsed light and fractional laser. CO₂ laser and erbium:YAG laser are not recommended for Asian patients because of high risks of postinflammatory hyperpigmentation. Refractory melasma can be treated with chemical peeling or dermabrasion, and dermabrasion may result in persistent clearance of melasma in 97% of patients.

Chloasma; Therapeutic uses; External application drugs; Lasers; Chemexfoliation