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.
Competing Interests: Conflicts of interest Dr Desai has served as a consultant and/or investigator for Galderma, Pfizer, Dermavant, Scientis, AbbVie, and several other organizations. He also serves in multiple leadership roles with dermatologic organizations. Dr Alexis has received grants from LEO Pharma, Novartis, Almirall, Bristol Myers Squibb, Amgen, Vyne, Galderma, Valeant (now Bausch Health), Cara, Arcutis, Dermavant, AbbVie, and Castle and consulting fees or honoraria from Leo, Galderma, Pfizer, Sanofi-Regeneron, Dermavant, Beiersdorf, Ortho, L’Oreal, Bristol Myers Squibb, Bausch Health, UCB, Vyne, Arcutis, Janssen, Allergan, Almirall, AbbVie, Sol-Gel, Amgen, VisualDx, Eli Lilly, Swiss American, Cutera, Cara, EPI, and Incyte. He has also received speaker fees from Regeneron, Sanofi-Genzyme, Pfizer, and Bristol Myers Squibb. Dr Elbuluk has received fees, research funding, or stock options for consulting, speaking, or participating in advisory boards from Allergan, Avita Medical, Beiersdorf, Estée Lauder, Galderma Laboratories, Incyte, Janssen, La Roche-Posay, L’Oreal, Scientis, Unilever, and VisualDx. Dr Grimes has served as a consultant and/or investigator for Procter & Gamble, Clinuvel, L’Oreal, Galderma Laboratories, LaserOptek, Versicolor Technologies, Incyte, Pfizer, AbbVie/Allergan, and SkinBetterScience. Dr Weiss served on the advisory board for Galderma Laboratories and Valeant Pharmaceuticals International (now Bausch Health), receiving honoraria. He also served as consultant for Abbott Laboratories, Celgene Corporation, LEO Pharma, and Sebacia, receiving honoraria. Dr Hamzavi is a consultant to AbbVie, Pfizer, Incyte, UCB, Boerhinger Ingelheim, Sonoma, Union therapeutics, Novartis, Janssen, Avita, and for Galderma Laboratories. Dr Hamzavi is an investigator for LENICURA, Pfizer, Incyte, Avita, and L’Oreal/La Roche-Posay. He is a board member and past president of the HS Foundation and Global Vitiligo Foundation. Dr Taylor reports service as an investigator for Concert Pharmaceuticals, Croma-Pharma, Eli Lilly, and Pfizer. Dr Taylor has received salaries, fees, honoraria, and stock options as a consultant, advisor, board member, and speaker for Mercer Strategies, AbbVie, Arcutis Biotherapeutics, Armis Scientific, Beiersdorf, Biorez, Cara Therapeutics, EPI Pharma, Evolus, Galderma Laboratories, Glo Getter, Hugel America, Janssen, Johnson & JohnsonJohnson & Johnson, L’Oreal, Medscape/WebMD, MJH Life Sciences, Piction Health, Regeneron, Scientis US, UCB, and Vichy Laboratoires.
(Published by Elsevier Inc.)