Delphi consensus on melasma management by international experts and pigmentary disorders society

国际专家与色素性疾病学会关于黄褐斑管理的德尔菲共识

Abstract

Background: Melasma, an acquired hyperpigmentation disorder, affects individuals of all ethnicities. Its multifactorial aetiology, high recurrence rates and psychosocial impact complicate management and necessitate comprehensive, evidence-based recommendations.

Objectives: The objective was to develop an international consensus on the diagnosis and management of melasma by synthesizing expert opinions and the latest scientific evidence.

Methods: This consensus was developed using a modified Delphi approach. A core group of two senior dermatologists who were experts in pigmentary disorders guided the process, and a diverse panel of 38 dermatologists with a special interest in pigmentary disorders from 11 countries (Australia, Brazil, France, India, Italy, Mexico, Philippines, South Africa, South Korea, Taiwan and the USA) participated in three rounds of surveys and discussions, under the aegis of the Pigmentary Disorders Society (PDS). A literature search of articles published between 2014 and 2024 identified key studies that were graded using the Oxford levels of evidence (2009). Consensus statements were drafted, refined and finalized based on expert feedback. Responses were assessed using a 5-point Likert scale, with predefined thresholds for high (≥75%), moderate (55%-74%) and low (<55%) agreement.

Results: The consensus development process started with 34 statements, and at the end of the third round of the Delphi process, 21, 4 and 1 statement reached high, moderate and low consensus, respectively. Key recommendations highlighted photoprotection with broad-spectrum sunscreens as essential, regulated and supervised use of hydroquinone-based triple combination creams as the gold standard, and alternatives such as topical azelaic acid, kojic acid and oral tranexamic acid. Adjunctive procedural therapies, such as chemical peels and microneedling, were suggested to enhance topical efficacy, while lasers were reserved for refractory cases.

Conclusions: These recommendations aim to improve the outcomes of melasma patients globally by integrating expert opinion and evidence-based strategies. Future research should focus on evaluating emerging therapies and optimizing long-term maintenance strategies.

背景：黄褐斑是一种获得性色素沉着性疾病，影响所有种族的人群。其多因素病因、高复发率和心理社会影响使管理复杂化，需要全面的、基于证据的建议。

目的：旨在通过综合专家意见和最新科学证据，制定关于黄褐斑诊断和管理的国际共识。

方法：本共识采用改良德尔菲方法制定。由两名色素性疾病专家资深皮肤科医生组成的核心小组指导整个过程，来自11个国家（澳大利亚、巴西、法国、印度、意大利、墨西哥、菲律宾、南非、韩国、台湾和美国）的38名对色素性疾病有特殊兴趣的皮肤科医生组成的多元化专家组，在色素性疾病学会（PDS）的主持下，参与了三轮调查和讨论。对2014年至2024年间发表的文献进行检索，确定了关键研究，并使用牛津证据等级（2009）进行分级。根据专家反馈起草、完善并最终确定共识声明。采用5点Likert量表评估回答，预设高（≥75%）、中（55%-74%）和低（<55%）一致性阈值。

结果：共识制定过程以34项声明开始，在德尔菲流程第三轮结束时，分别有21项、4项和1项声明达到高、中、低一致性。关键建议强调使用广谱防晒霜进行光防护至关重要，规范并在监督下使用基于氢醌的三联组合霜作为金标准，以及替代方案如外用壬二酸、曲酸和口服氨甲环酸。建议采用辅助性程序治疗，如化学剥脱和微针，以增强外用药物的疗效，而激光则保留用于难治性病例。

结论：这些建议旨在通过整合专家意见和基于证据的策略，改善全球黄褐斑患者的结局。未来研究应侧重于评估新兴疗法和优化长期维持治疗策略。

Sarkar R, Desai SR, Sinha S, Dogra S, Arellano-Mendoza MI, Ailawadi P, Aurangabadkar S, Bagatin E, Barua S, Bhalla M, Cassiano D, Cestari T, Das A, Dayrit J, Dlova N, Lan CE, Elbuluk N, Espósito AC, Handog E, Jagadeesan S, Katoch S, Sendhil Kumaran M, Kumarasinghe P, Macarayo MJ, Miot HA, Mysore V, Narayan R V, Oh SH, Passeron T, Picardo M, Podder I, Sachdeva S, Sharma A, Sharma R, Somani V, Swarnkar B, Taylor S, Thappa DM, Vinay K, Lim HW. Delphi consensus on melasma management by international experts and pigmentary disorders society. J Eur Acad Dermatol Venereol. 2026 Apr;40(4):680-692.

20250925-德尔菲共识.pdf