Best practices in the treatment of melasma with a focus on patients with skin of color

Background: Melasma is a chronic hypermelanosis of the skin that affects approximately 1% of the global population, predominantly affects women, and is more prevalent in skin of color. Melasma is a common driver for patients with skin of color to seek out a dermatologist for treatment, and ensuring the right approach for these patients is important because some treatments may be associated with adverse side effects. Because of the chronicity of the disease and established psychosocial and emotional impacts, there is a large need to ensure care follows the best available evidence on the treatment of patients with melasma. Objective: Here, we summarized current available topical treatments for melasma with considerations dermatologists should have for their patients with skin of color. Methods: Steering committee consensus on clinical best practices. Results: We describe a flexible and focused treatment algorithm that reflects both treatment and maintenance periods that is a consensus of our extensive clinical experience. Limitations: Use of real-world evidence and potential for individual practice bias. Conclusion: Melasma can be challenging to treat, particularly in patients with skin of color, and our recommendations for best practices for patients in the United States are an important step toward standardizing care.