Year: 2026
Type: review
Abstract: Vitiligo and melasma frequently coexist, creating a treatment dilemma, since agents effective for one condition can destabilize the other, and no consensus currently exists on safe management. We conducted a scoping literature review (through June 2023) on treatment of patients with concomitant vitiligo and melasma, followed by a two-round international e-Delphi survey (22 experts from 14 countries; consensus defined as ≥ 70% agreement) and a final online consensus meeting. Only one study supported the safe use of oral tranexamic acid for melasma in vitiligo patients. Expert consensus favored prioritizing vitiligo treatment, particularly when active, while incorporating patient's preferences. Targeted phototherapy is suitable for localized facial lesions of vitiligo, and non-facial vitiligo can be treated alongside melasma after covering the face. Topical calcineurin inhibitors, ruxolitinib, tretinoin, corticosteroids, and oral tranexamic acid can be used. Lasers and chemical peels were recommended only with caution by experienced pigment specialists. Until there is enough scientific evidence, hydroquinone would be replaced by other safer cosmetic lightening agents (e.g., niacinamide, ascorbic acid, thiamidol, melasyl), which show comparable efficacy with less theoretical risk. This first international consensus offers practical, patient-centered guidance for managing coexisting vitiligo and melasma, emphasizing individualized, disease-activity-based treatment sequencing. Trial Registration: PROSPERO reference number: RD42023395586 Significance. Depigmenting agents used for melasma inhibit melanogenesis, a mechanism that can further compromise the already-stressed melanocyte populations characteristic of vitiligo. This consensus gives clinicians an expert-informed pathway through a common but understudied comorbidity. It also identifies a clear research gap: controlled, mechanistic comparisons of hydroquinone against newer tyrosinase inhibitors specifically in vitiligo-prone skin are still lacking.
Source: Pigment Cell & Melanoma Research
DOI: 10.1111/pcmr.70125
Authors: Marwa Abdallah, Khaled Ezzedine, Thierry Passeron, Viktoria Eleftheriadou, Laila Benzekri, Caio Cesar Silva de Castro, Nada Elbuluk, Samia Esmat, Andrea Tovar‐Garza, Iltefat H. Hamzavi, Hyun Jeong Ju, Prasad Kumarasinghe, Jung Min Bae, Tasneem F. Mohammad, Davinder Parsad, Noufal Raboobee, Michelle Rodrigues, Julien Seneschal, Steven Thng, Nanja Van Geel, Albert Wolkerstorfer, Mahy El‐Bassiouny
Institutions: Ain Shams University, Université Paris-Est Créteil, Hôpitaux Universitaires Henri-Mondor, Epidemiology in dermatology and evaluation of therapeutics, Inserm, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Centre Méditerranéen de Médecine Moléculaire, Walsall Healthcare NHS Trust, The Royal Wolverhampton NHS Trust, University of Birmingham, Mohammed V University, Centre Hospitalier Ibn Sina, University of Southern California, Cairo University, Henry Ford Health, Henry Ford Hospital, The Catholic University of Korea St. Vincent's Hospital, Catholic University of Korea, The University of Western Australia, Post Graduate Institute of Medical Education and Research, Royal Children's Hospital, Centre National de la Recherche Scientifique, Hôpital Saint-André, Immunology from Concept and Experiments to Translation, Agency for Science, Technology and Research, Skin Research Institute of Singapore, Ghent University Hospital, Amsterdam University Medical Centers, University of Amsterdam
Language: English
Subfield: Cell Biology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W7223003951