Update on Melasma Management

Melasma is a complex hyperpigmentary disorder with a multifactorial etiology. There are multiple treatment options that aim at achieving pigment homeostasis , by either decreasing melanin production or accelerating its elimination. The mainstay of melasma management remains diligent photoprotection and topical therapy, such as hydroquinone and triple therapy (hydroquinone, retinoid , and steroid) creams. Additional novel topical treatments can be considered, such as tranexamic acid , cysteamine , azelaic acid , methimazole , metformin , and botanic agents like Rumex occidentalis. Microneedling as an adjuvant to topical therapies is an appropriate step-up second-line option.