For clinical practice healthcare providers

From the available evidence, treatments likely to benefit patients with melasma are azelaic acid with sunscreens and 2-4% hydroquinone with sunscreens. The use of hydroquinone for melasma has been limited recently because of several case reports of it causing exogenous ochronosis. However, there were no reports of this side-effect in any studies with a follow up for up to 24 months.

We did not find convincing evidence for the effectiveness of topical retinoids, topical corticosteroids, glycolic acid, oral vitamins E or C, lasers or any combined therapies.

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