Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta‐analysis. (25th December 2022)

• Record Type: Journal Article
• Authors: Chang, Yu‐Feng; Lee, Tai Lin; Oyerinde, Oyetewa; Desai, Seemal R.; Aljabban, Ali; Bay, Camden P.; Bain, Paul A.; Chung, Hye Jin
• Is Part Of: Journal of cosmetic dermatology. Volume 22:Number 4(2023)
• Page Start: 1168
• Page End: 1176
• Publication Date: 2022-12-25
• Subjects: melasma -- meta‐analysis -- topical treatment; Skin -- Diseases -- Treatment -- Periodicals; Lasers in surgery -- Periodicals; Skin -- Pathophysiology -- Periodicals; Surgery, Plastic -- Periodicals; 616.5
• DOI: 10.1111/jocd.15566
• Languages: English
• ISSNs: 1473-2130

Abstract

Abstract: Background: Various topical agents have been used to treat melasma; however, a large‐scale evaluation among the currently available treatment is lacking. Objectives: The aim of this study was to evaluate the efficacy and safety of topical agents for melasma. Methods: The MEDLINE, Embase, Web of Science, Cochrane, and Alt‐Healthwatch databases were searched in November 2021. Original studies that reported pre‐ and post‐treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre‐ and post‐treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations. Results: A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD ‐1.3, 95% CI [−1.6 to −1.0]), HQ‐containing combination therapy (−1.4, [−1.7 to −1.1]), cysteamine (−1.6, [−2.0 to −1.2]), tranexamic acid (−1.5, [−2.0 to −1.1]), azelaic acid (−1.3, [−1.7 to −1.0]), and kojic acid (−0.9, [−1.3 to −0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (−1.2, [−2.7 to 0.4]). HQ‐containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk. Conclusions: In this meta‐analysis, non‐HQ agents except zinc sulfate may be considered as an alternative to HQ‐containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.