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Melasma is a chronic skin condition that involves the overproduction of melanin in areas exposed to ultraviolet radiation. Melasma treatment is long-term and complicated with recurrence and resistance to treatment. The pathogenesis of melasma is highly complex with multiple pathologies occurring outside of the skin pigment cells. It includes photoaging, excessive melanogenesis, an increased number of mast cells, increased vascularization, and basement membrane damage. In addition, skin lesions related to melasma and their surrounding skin have nearly 300 genes differentially expressed from healthy skin. Traditionally, melasma was treated with topical agents, including hydroquinone, tretinoin, glucocorticosteroids and various formulations; however, the current approach includes the topical application of a variety of substances, chemical peels, laser and light treatments, mesotherapy, microneedling and/or the use of systemic therapy. The treatment plan for patients with melasma begins with the elimination of risk factors, strict protection against ultraviolet radiation, and the topical use of lightening agents. Hyperpigmentation treatment alone can be ineffective unless combined with regenerative methods and photoprotection. In this review, we show that in-depth knowledge associated with proper communication and the establishment of a relationship with the patient help to achieve good adherence and compliance in this long-term, time-consuming and difficult procedure.

Melasma is a recurrent and treatment‐resistant hyperpigmentation disorder characterized by a complex and multifactorial pathogenesis. However, the lack of a stable and reliable animal model has hindered systematic investigations into its onset and progression. In this study, we established a melasma‐like model in C57BL/6J mice by combining broadband UVB irradiation, intramuscular progesterone administration, and induced emotional stress. The affected skin areas exhibited irregular, brown hyperpigmented patches. Histopathological analysis revealed an accumulation of melanin granules in the epidermis and superficial dermis, elevated levels of tyrosinase (TYR) in both skin and plasma, systemic oxidative stress imbalance, and reduced autophagic activity in the lesional skin. Furthermore, this model displayed distinct differences from a UV‐induced post‐inflammatory hyperpigmentation (PIH) model. Notably, the melasma‐like mice responded to tranexamic acid treatment in a manner that closely resembled clinical outcomes observed in human patients. Collectively, these findings establish a stable, reproducible, and clinically relevant mouse model of melasma, providing a valuable platform for future research into its pathogenesis and treatment. A melasma‐like mouse model was established in C57BL/6J mice using a combination of UVB irradiation, progesterone administration, and chronic psychological stress. This model replicates key clinical features and biomarker alterations observed in human melasma. Importantly, it is fundamentally distinct from UV‐induced post‐inflammatory hyperpigmentation (PIH) and exhibits a therapeutic response to tranexamic acid treatment.

Background: Melasma is a common acquired facial hypermelanosis. While mostly diagnosable clinically, Wood's lamp and dermoscopy can aid in differentiating melasma types based on pigment distribution. Aims: To study the clinico-dermoscopic distribution of melasma and compare it with Wood's lamp finding. Methods: A total of 140 patients with melasma attending the Dermatology OPD of a tertiary care hospital over a duration of 12 months were included in this cross-sectional analytical study. Patients were subjected to clinical examination, Wood's lamp examination, and dermatoscopic examination. Noted findings were recorded and analyzed for descriptive values and associations. Results: Among 140 patients, 123 were females and 17 were males, with a mean age of 33.49 ± 7.65 years. Clinically, 78 (55.7%) had centrofacial distribution, 55 (39.3%) had malar distribution, and 7 (5%) had a mandibular distribution of lesions. Wood's lamp examination showed epidermal type in 64 (47.71%), mixed type in 60 (42.9%), and dermal type in 16 (11.4%). Dermoscopic examinations revealed an epidermal pattern in 79 (56.42%), a dermal pattern in 6 (4.2%), and a mixed type in 55 (39.28%). The most common dermoscopic finding was an exaggerated pseudoreticular network, followed by reticuloglobular pattern, arciform structures, and patternless hyperpigmentations, respectively. The association between color on clinical examination and melasma type by dermoscopy was significant (Cramer's V = 0.535, P-value = 0.000). The degree of agreement between Wood's lamp examination and dermoscopic examination was significant with a moderate agreement, (κ = 0.548 P < 0.0005). Conclusion: Although dermoscopy can be used more effectively, both Wood's lamp and dermoscopy can aid in the diagnosis and determination of pigment distribution in melasma, promising effective intervention, and prognosis assertion.

Background: Melasma is a challenging hyperpigmentation disorder without absolute treatment. Aims: This study aimed to evaluate the effects of intradermal botulinum toxin A (BoNT‐A) on melasma and the protective effects of BoNT‐A on UVA‐induced melanogenesis in B16F10 melanoma cells. Patients/Methods: This study is a split‐face randomized, double‐blind, placebo‐controlled trial in 12 melasma patients who received intradermal abobotulinumtoxinA injection into melasma lesions. An in vitro study was also conducted in B16F10 melanoma cells treated with different concentrations of BoNT‐A prior to exposure to UVA. Cell viability and cellular melanogenesis were determined. Results: The adjusted MASI scores on the BoNT‐A side were significantly lower than the control at 3 months after injection, 2.8 versus 4.5 ( p < 0.001), respectively. BoNT‐A injection significantly reduced the MASI score at 2 and 3 months compared with the baseline of 4.1–3.2 (22%) ( p < 0.001) and 2.8 (31.7%) ( p < 0.001), respectively. Melanin content and tyrosinase activity in B16F10 cells with or without UVA irradiation were significantly reduced by treatment with BoNT‐A in a dose‐dependent manner without causing cytotoxicity. Conclusions: BoNT‐A has a potentially beneficial effect in the treatment of melasma due to its antimelanogenic effect. Trial Registration: Clinical Trial Registry identifier: TCTR20250118001

Melasma is a benign skin condition characterized by hyperpigmented patches, primarily affecting the face, and significantly reducing patients’ quality of life. Treatment is challenging due to its recurrent nature, with no single modality proving universally effective. The combination of Q-switched Nd:YAG laser treatment and FOB® Tri-White Serum (Hong Nhung Cosmetics Co., Ltd., Can Tho, Vietnam) may represent a promising new therapeutic approach. This cross-sectional descriptive study involved 85 female patients with melasma treated at two dermatological centers between July 2023 and June 2024. Patients underwent four Q-switched Nd:YAG laser sessions (1064 nm, 1.5-1.7 J/cm2) at three-week intervals and applied FOB® Tri-White Serum twice or three times daily. Treatment effectiveness was assessed using the Melasma Area Severity Index (MASI) score and the Felix Von Luschan skin color chart. Data were analyzed using Stata 17.0 MP, with p<0.05 considered statistically significant. The mean MASI score improved significantly from 7.5±4.7 to 4.9±3.5 (p<0.05), with a 69.4% response rate. Younger patients (<45 years), individuals with a shorter disease duration (≤36 months), and cases of mild to moderate melasma exhibited more favorable outcomes. Adverse effects from both the laser and serum were mild and transient. The combination of Q-switched Nd:YAG laser and FOB® Tri-White Serum is a safe and effective treatment for melasma, demonstrating significant improvement in pigmentation with minimal side effects. Further research is needed to validate these findings with larger sample sizes and control groups.

Context: Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways. Aims: The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma. Settings and Design: This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist. Methods and Materials: The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI). Results: Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann-Whitney U test revealed significantly more perceived stress (P = 0.001), more disability (P = 0.000) and anxiety-depression on HADS (P = 0.0 16) in cases than in their relatives. Limitations: This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study. Conclusions: There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.

Background: Melasma is a common hyperpigmentation skin disorder with a high recurrence rate. Mast cell activation plays a role in its pathogenesis, with melanocyte activation via histamine receptor 2 (H2R) considered a potential mechanism. This study aims to evaluate the efficacy of topical famotidine combined with 1927 nm thulium fractional laser in treating melasma and reducing recurrence. Methods: The study was designed as a split‐face, randomized‐controlled, single‐blind trial. Participants underwent four full‐face 1927 nm fractional laser treatments at 4‐week intervals and applied 2% famotidine solution on a randomly assigned side and control solution on the opposite side of the face twice daily for 16 weeks. Skin assessments including VISIA imaging, modified melasma area severity index (mMASI) score, and DermaLab skin color detection were conducted by blinded dermatologists at Weeks 0, 4, 8, 12, and 16. Self‐assessment scores and the melasma quality of life (MELASQoL) index were collected at baseline and Week 16. Long‐term follow‐up was performed at Week 64. All side effects were recorded. Statistical analyses included paired t ‐tests, repeated measures ANOVA, and Wilcoxon and Friedman tests. Results: A total of 16 patients were enrolled in the study. At Week 16, the famotidine‐treated side showed significant reductions in mMASI ( p = 0.019,  = 0.598) and melanin index (MI) ( p = 0.006,  = 0.672), with a slight improvement in erythema index (EI). ∆MI was significantly lower on the famotidine‐treated side than the control ( p = 0.012, Cohen’s d = 0.710). Both MELASQoL scores and patient self‐assessments improved, with no obvious adverse effects observed. Long‐term evaluation at Week 64 revealed sustained improvement in mMASI on the famotidine‐treated side compared to the control side ( p = 0.029, Cohen’s d = 0.686). Conclusions: This study provides clinical evidence supporting H2R blockade as a potential melasma treatment. Famotidine may enhance laser efficacy and modulate histamine‐mediated melanogenesis, offering long‐term benefits in reducing recurrence. Trial Registration: ClinicalTrials.gov identifier: NCT06313307

Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1–50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos , and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.

Xinjin Liu,1,2,* Xu Liu,1,2,* Yanbing Han,1,2 Yifei Cheng,1,2 Hongjie Luo,1,2 Yichen Liu,1,2 Dingling Li,1,2 Weihong Guo,1,2 Haoyu Jiang,1,2 Linghong Guo,1,2 Xian Jiang1,2 1Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China; 2Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xian Jiang, Department of Dermatology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, People’s Republic of China, Tel +86 189 8060 1693, Email jiangxian@scu.edu.cn Linghong Guo, Department of Dermatology, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, People’s Republic of China, +86 18380131660, Email Linhom.guo@foxmail.comPurpose: To identify the primary concerns and unmet needs of patients with melasma on social media using qualitative analysis and AI-based keyword extraction.Patients and Methods: We conducted a qualitative study of melasma patient discussions using publicly available posts on Facebook and Baidu. The data were collected between January 2014 and October 2024. ChatGPT-4o was used for keyword extraction and classification.Results: A total of 1106 related posts were analyzed, revealing 284 unique tags and 2434 keywords. Treatment and prevention were the most discussed topics, with patients seeking information on effective, long-term, and affordable treatment. Daily care and mental health accounted for 29.2% of the total, focusing on skincare routines, sun protection, and lifestyle modification. Etiology and clinical features were observed in 14.8% of the posts, whereas 2.4% addressed diagnosis and differentiation.Conclusion: This study identified key concerns of patients with melasma using AI-based keyword extraction and qualitative analysis, highlighting the need for healthcare professionals to engage in digital patient education, clarify misinformation, support patient self-management, and integrate mental health considerations into melasma care. Future research should focus on AI-based interventions to enhance patient engagement and self-management.Keywords: melasma, patient education, social media, artificial intelligence, digital health

Arbutin is a compound of hydroquinone and D-glucose, and it has been over 30 years since there have been serious studies on the skin lightening action of this substance. In the meantime, there have been debates and validation studies about the mechanism of action of this substance as well as its skin lightening efficacy and safety. Several analogs or derivatives of arbutin have been developed and studied for their melanin synthesis inhibitory action. Formulations have been developed to improve the stability, transdermal delivery, and release of arbutin, and device usage to promote skin absorption has been developed. Substances that inhibit melanin synthesis synergistically with arbutin have been explored. The skin lightening efficacy of arbutin alone or in combination with other active ingredients has been clinically evaluated. Combined therapy with arbutin and laser could give enhanced depigmenting efficacy. The use of arbutin causes dermatitis rarely, and caution is recommended for the use of arbutin-containing products, especially from the viewpoint that hydroquinone may be generated during product use. Studies on the antioxidant properties of arbutin are emerging, and these antioxidant properties are proposed to contribute to the skin depigmenting action of arbutin. It is hoped that this review will help to understand the pros and cons of arbutin as a cosmetic ingredient, and will lead to future research directions for developing advanced skin lightening and protecting cosmetic products.