TY - JOUR
T1 - Efficacy and safety of topical agents in the treatment of melasma
T2 - What's evidence? A systematic review and meta-analysis
AU - Chang, Yu Feng
AU - Lee, Tai Lin
AU - Oyerinde, Oyetewa
AU - Desai, Seemal R
AU - Aljabban, Ali
AU - Bay, Camden P.
AU - Bain, Paul A.
AU - Chung, Hye Jin
N1 - Publisher Copyright:
© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - melasma
KW - meta-analysis
KW - topical treatment
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U2 - 10.1111/jocd.15566
DO - 10.1111/jocd.15566
M3 - Review article
C2 - 36566490
AN - SCOPUS:85145239885
SN - 1473-2130
VL - 22
SP - 1168
EP - 1176
JO - Journal of Cosmetic Dermatology
JF - Journal of Cosmetic Dermatology
IS - 4
ER -