PMID- 36566490
OWN - NLM
STAT- MEDLINE
DCOM- 20230331
LR  - 20230331
IS  - 1473-2165 (Electronic)
IS  - 1473-2130 (Linking)
VI  - 22
IP  - 4
DP  - 2023 Apr
TI  - Efficacy and safety of topical agents in the treatment of melasma: What's 
      evidence? A systematic review and meta-analysis.
PG  - 1168-1176
LID - 10.1111/jocd.15566 [doi]
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.
CI  - (c) 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley 
      Periodicals LLC.
FAU - Chang, Yu-Feng
AU  - Chang YF
AUID- ORCID: 0000-0001-6055-5102
AD  - Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
AD  - Harvard Medical School, Boston, Massachusetts, USA.
AD  - Brigham and Women's Hospital, Boston, Massachusetts, USA.
FAU - Lee, Tai Lin
AU  - Lee TL
AD  - Center for Global Health, Perelman School of Medicine, University of 
      Pennsylvania, Philadelphia, Pennsylvania, USA.
FAU - Oyerinde, Oyetewa
AU  - Oyerinde O
AD  - Harvard Combined Dermatology Residency Training Program, Boston, Massachusetts, 
      USA.
FAU - Desai, Seemal R
AU  - Desai SR
AD  - Department of Dermatology, The University of Texas Southwestern Medical Center 
      and Innovative Dermatology, Dallas, Texas, USA.
FAU - Aljabban, Ali
AU  - Aljabban A
AD  - Harvard Medical School, Boston, Massachusetts, USA.
AD  - Brigham and Women's Hospital, Boston, Massachusetts, USA.
FAU - Bay, Camden P
AU  - Bay CP
AD  - Brigham and Women's Hospital, Boston, Massachusetts, USA.
FAU - Bain, Paul A
AU  - Bain PA
AD  - Countway Library, Harvard Medical School, Boston, Massachusetts, USA.
FAU - Chung, Hye Jin
AU  - Chung HJ
AUID- ORCID: 0000-0003-0204-4085
AD  - Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
AD  - Harvard Medical School, Boston, Massachusetts, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20221225
PL  - England
TA  - J Cosmet Dermatol
JT  - Journal of cosmetic dermatology
JID - 101130964
RN  - F2VW3D43YT (azelaic acid)
RN  - 6T84R30KC1 (Tranexamic Acid)
RN  - 5UX2SD1KE2 (Cysteamine)
RN  - 7733-02-0 (Zinc Sulfate)
RN  - XV74C1N1AE (hydroquinone)
SB  - IM
MH  - Humans
MH  - Treatment Outcome
MH  - *Tranexamic Acid/adverse effects
MH  - Cysteamine
MH  - Zinc Sulfate
MH  - *Melanosis/drug therapy
OTO - NOTNLM
OT  - melasma
OT  - meta-analysis
OT  - topical treatment
EDAT- 2022/12/26 06:00
MHDA- 2023/03/31 06:42
CRDT- 2022/12/25 14:06
PHST- 2022/10/31 00:00 [received]
PHST- 2022/12/01 00:00 [accepted]
PHST- 2023/03/31 06:42 [medline]
PHST- 2022/12/26 06:00 [pubmed]
PHST- 2022/12/25 14:06 [entrez]
AID - 10.1111/jocd.15566 [doi]
PST - ppublish
SO  - J Cosmet Dermatol. 2023 Apr;22(4):1168-1176. doi: 10.1111/jocd.15566. Epub 2022 
      Dec 25.