Key points

• No incontrovertible or solid evidence supports preventive interventions in high-risk populations. Current opinion, based on known risk factors, suggests that preventing exposure to sources of ultraviolet light such as sunlight may reduce the risk of developing melasma.

• No incontrovertible evidence supports any therapeutic intervention in pregnant or breastfeeding women. Current opinion suggests that such women with melasma may benefit from using broad-spectrum sunscreens and avoiding exposure to ultraviolet light such as sunlight.

2. Estrada-Castanon R, Torres-Bibiano B, Alarcon-Hernandez H et al. Epidemiología cutánea en dos sectores de atención médica en Guerrero, Mexico. Dermato Rev Mex 1992;36:29-34.

3. Failmezger C. Incidence of skin disease in Cuzco, Peru. Int J Dermatol. 1992;31:560-1.

4. Halder RN, Grimes PE, McLaurin CI, Kress MA, Kennery JA Jr. Incidence of common dermatoses in a predominantly black dermatologic practice. Cutis 1983;32:388-90.

5. Pathak MA, Fitzpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol. 1986; 15:894-9.

6. Bleehem SS. Disorders of skin colour. In: Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Textbook of Dermatology, 6th ed. Oxford: Blackwell Science, 1998:1753-1815.

7. Resnick S. Melasma induced by oral contraceptive drugs. JAMA 1967;199:601-5.

8. Escoda ECJ. Chloasma from progestational oral contraceptives. Arch Dermatol 1967;87:486.

9. Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Minhm MC Jr. Melasma a clinical, light microscopic, ultrastructural and immunofluorescence study. J Am Acad Dermatol 1981;4:698-710.

10. Vazquez M, Maldonado H, Benaman C, Sanchez JL. Melasma in men: a clinical and histologic study. Int J Dermatol 1988;27:25-7.

11. Perez M, Samchez JL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol 1983;81:543-5.

12. Lufti RJ, Fridmanis M, Misrunas AL. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of melasma. J Clin Endocrinol Metab 1985;61:28-31.

13. Smith AG, Shuster S, Thody AJ et al. Chloasma, oral contraceptives, and plasma immunoreactive beta-melanocyte-stimulating hormone. J Invest Dermatol 1977:169-170.

14. Findley GH, Morrison JGL, Simon IW. Exogenous ochronosis and pigmented colloid milium from hydroquinone bleaching creams. Br J Dermatol. 1975;93:613-22.

15. Gilchrest BA, Fitzpatrick TB, Anderson RR, Parish JA. Localization of melanin pigmentation in the skin with Wood's lamp. Br J Dermatol 1977;96:245-8.

16. Fitzpatrick TB. Validity and practicality of sun-reaction types I—VI. Arch Dermatol 1988;124:869-71.

17. Leenutaphong V, Nettakul A, Rattanasuwon P. Topical isotretinoin for melasma in Thai patients: a vehicle-controlled clinical trial. J Med Assoc Thai 1999;82: 868-75.

18. Graupe K, Verallo RVM, Verallo V, Zaumseil RP. Combined use of 20% azelaic acid cream and 0-05% tretinoin cream in the topical treatment of melasma. J Dermatol Treat 1996;7:235-7.

19. Vazquez M, Sanchez JL. The efficacy of a broad-spectrum sunscreen in the treatment of melasma. Cutis 1983;32:92-6.

20. Neering H. Treatment of melasma (cholasma) by local application of a steroid cream. Dermatologica 1975;151:349-53.

21. Griffiths CE, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ. Topical tretinoin (retinoic acid) improves melasma. A vehicle-controlled, clinical trial. Br J Dermatol 1993;129:415-21.

22. Krimbrough-Green CK, Griffiths CEM, Finkel LJ et al. Topical retinoic acid (tretinoin) for melasma in black patients. Arch Dermatol 1994;130:727-33.

23. Lowe NJ, Rizk D, Grimes P, Billips M, Pincus S. Azealic acid 20% cream in the treatment of facial hyperpigmentation in darker-skinned patients. Clin Ther 1998;20:945-59.

24. Sivayathorn A, Verallo RV, Graupe K. 20% azelaic acid cream in the topical treatment of melasma: A double-blind comparison with 2% hydroquinone. Eur J Dermatol 1995;5:680-4.

25. Piquero-Martin J, Rothe de Arocha J, Beniamini Loker D. Estudio clínico doble ciego en el tratamiento del melasma entre ácido azelaico versus hidroquinona. Med Cut I LA 1988;16:511-14.

26. Ennes SBP, Paschoalick RC, Mota M. A double blind, comparative, placebo-controlled study of the efficacy and tolerability of 4% hydroquinone as a depigmenting agent in melasma. J Dermatol Treat 2000;11:173-9.

27. Lim JT, Tham SN. Glycolic acid peels in the treatment of melasma among Asian women. Dermatol Surg 1997;23:177-9.

28. Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol 1997;36:589-93.

29. Kakita LS, Lowe NJ. Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: A clinical comparison with hydroquinone. Clin Ther 1998;20:960-70.

30. Lim JT. Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatol Surg 1999;25:282-4.

31. Poli F, Lakhdar H, Souissi R, Fiquet E, Chanez JF. Clinical evaluation of a depigmenting cream: Trio-D (R) in melasma of the face. Nouv Dermatol 1997;16: 193-7.

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33. Pathak MA. Treatment of melasma with hydroquinone. J Invest Dermatol 1981;76:324.

34. Nouri K, Bowes L, Chartier T, Romagosa R, Spencer J. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser:a pilot study. Dermatol Surg 1999;25:494-7.

35. Hayakawa R, Ueda H, Nozaki T etal. Effects of combination treatment with vitamins E and C on cholasma and pigmented contact dermatitis. A double blind controlled clinical trial. Acta Vitaminol Enzymol 1981;3:31-8.

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