Melasma Treatment: An Evidence-Based Review

黄褐斑治疗：一项基于证据的综述

Background: Melasma is an acquired, chronic pigmentary disorder predominantly affecting women. It may significantly affect quality of life and self-esteem due to its disfiguring appearance. Multiple treatments for melasma are available, with mixed results.

Objective: The aim of this article was to conduct an evidence-based review of all available interventions for melasma.

Methods: A systematic literature search of the PubMed electronic database was performed using the keywords 'melasma' and/or 'chloasma' in the title, through October 2018. The search was then limited to 'randomized controlled trial' and 'controlled clinical trial' in English-language journals. The Cochrane database was also searched for systematic reviews.

Results: The electronic search yielded a total of 212 citations. Overall, 113 studies met the inclusion criteria and were included in this review, with a total of 6897 participants. Interventions included topical agents, chemical peels, laser- and light-based devices, and oral agents. Triple combination cream (hydroquinone, tretinoin, and corticosteroid) remains the most effective treatment for melasma, as well as hydroquinone alone. Chemical peels and laser- and light-based devices have mixed results. Oral tranexamic acid is a promising new treatment for moderate and severe recurrent melasma. Adverse events from all treatments tend to be mild, and mainly consist of skin irritation, dryness, burning, erythema, and post-inflammatory hyperpigmentation.

Conclusions: Hydroquinone monotherapy and triple combination cream are the most effective and well-studied treatments for melasma, whereas chemical peels and laser- and light-based therapies are equal or inferior to topicals, but offer a higher risk of adverse effects. Oral tranexamic acid may be a safe, systemic adjunctive treatment for melasma, but more studies are needed to determine its long-term safety and efficacy. Limitations of the current evidence are heterogeneity of study design, small sample size, and lack of long-term follow-up, highlighting the need for larger, more rigorous studies in the treatment of this recalcitrant disorder.

背景：黄褐斑是一种获得性、慢性色素障碍，主要影响女性。由于其损容性外观，可能显著影响生活质量和自尊。黄褐斑有多种治疗方法，但结果参差不齐。

目的：本文旨在对所有可用的黄褐斑干预措施进行基于证据的综述。

方法：使用关键词“melasma”和/或“chloasma”在标题中系统检索PubMed电子数据库截至2018年10月的文献。随后将检索限制为英文期刊中的“随机对照试验”和“对照临床试验”。同时检索Cochrane数据库中的系统评价。

结果：电子检索共获得212条引用。总体而言，113项研究符合纳入标准并纳入本综述，共计6897名参与者。干预措施包括外用药物、化学剥脱、激光和光基设备以及口服药物。三联乳膏（氢醌、维A酸和糖皮质激素）仍是黄褐斑最有效的治疗，单用氢醌亦然。化学剥脱和激光及光基设备的结果参差不齐。口服氨甲环酸是治疗中重度复发性黄褐斑的一种有前景的新疗法。所有治疗的不良事件往往较轻，主要包括皮肤刺激、干燥、灼烧、红斑和炎症后色素沉着。

结论：氢醌单药治疗和三联乳膏是黄褐斑最有效且研究最充分的治疗，而化学剥脱和激光及光基疗法与外用药物相当或劣于外用药物，但不良事件风险更高。口服氨甲环酸可能是黄褐斑一种安全的系统性辅助治疗，但需要更多研究来确定其长期安全性和有效性。当前证据的局限性在于研究设计的异质性、样本量小以及缺乏长期随访，突出表明需要针对这种难治性疾病开展更大规模、更严谨的研究。

McKesey J, Tovar-Garza A, Pandya AG. Melasma Treatment: An Evidence-Based Review. Am J Clin Dermatol. 2020 Apr;21(2):173-225.