International Consensus Clarifies Melasma Treatment Safety in Vitiligo

An international expert consensus sought to outline treatment strategies for patients with coexisting vitiligo and melasma, emphasizing disease activity, individualized treatment sequencing, and caution with depigmenting therapies.

Researchers conducted a scoping literature review through June 2023, followed by a two-round electronic Delphi survey involving 22 experts from 14 countries. Consensus required at least 70% agreement, with recommendations finalized during an online meeting. The paper was published in Pigment Cell & Melanoma Research.

Which Melasma Treatments Are Considered Safe in Patients With Vitiligo?

Experts favored treating vitiligo first, especially when active, while accounting for patient preferences. The authors considered targeted phototherapy suitable for localized facial vitiligo, while nonfacial vitiligo could be treated alongside melasma with facial protection. Consensus supported topical calcineurin inhibitors, ruxolitinib, tretinoin, corticosteroids, and oral tranexamic acid as potential treatment options. Lasers and chemical peels warranted caution and involvement of experienced pigment specialists.

The experts favored alternatives to hydroquinone, including niacinamide, ascorbic acid, thiamidol, and melasyl for melasma-related hyperpigmentation due to concerns about melanocyte injury, although evidence remains limited. The reviewers identified only one study supporting oral tranexamic acid safety, and controlled and there remains a lack of data comparing hydroquinone with newer lightening agents.

"This first international consensus offers practical, patient-centered guidance for managing coexisting vitiligo and melasma, emphasizing individualized, disease-activity-based treatment sequencing," the authors concluded.

Source

Abdallah M, et al. Pigment Cell Melanoma Res. Published online October 20, 2026. Doi:10.1111/pcmr.70125