Pigmentary disorders like melasma or vitiligo are very challenging to treat, and many patients often suffer from the negative psychosocial impact and significantly decreased quality of life.

Desai SR, a leading expert in skin care, mentions that a good knowledge of the diagnostic dilemmas, cutting-edge treatment options, and the latest clinical research regarding the diagnosis and management of pigmentary disorders are crucial necessities to find the optimal treatment and management plan in affected patients.

He advises that while approaching patients with skin of color, it is crucial to understand that no single therapy can achieve the perfect balance of skin lightening and maintaining cutaneous integrity, particularly in hyperpigmentation. Hence, it is important to consider a multi-therapy approach, possibly involving office-based procedures and/or newer, more literature-based treatment modalities.

Desai recommends the only FDA-approved combination branded formulation for melasma –contains hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01%. The hydroquinone content interrupts the formation and synthesis of melanin and lightens the skin, tretinoin increases the skin cell turnover rate to help exfoliate the skin, and the corticosteroid helps reduce inflammation in the target area. Further, he also recommends a compound therapy for melasma – hydroquinone-based triple combination lightening therapy consisting of hydroquinone ranging from 4% to 6%, tretinoin 0.025% and dexamethasone 0.1% for about 12 weeks. Desai advises regular use of broad-spectrum sunscreens and topical antioxidants, such as vitamin C, along with the chosen treatment modality, throughout the treatment course. 

For vitiligo, Desai mentions Janus kinase (JAK) inhibitors as a fascinating option for this patient population. The combination of antioxidants, oral therapies, laser and light therapies and topical JAK inhibitors also works for patients with vitiligo. Further, he advises that using tacrolimus 0.1% cream (twice weekly as a pulse monotherapy) can help stabilize the disease and prevent relapse.

Source: Petrou I. Diagnostic approaches for melasma and vitiligo. Dermatology Times. 2022;43(8).  Available from: https://www.dermatologytimes.com/view/diagnostic-approaches-for-melasma-and-vitiligo