Year: 2026
Type: article
Abstract: Melasma is an acquired skin hyperpigmentation caused by a multifactorial pathogenesis, including melanocyte hyperactivity, subclinical inflammation, and oxidative stress. Despite a wide range of topical and systemic treatments, recurrence rates remain high. The aim of this study was to evaluate the effectiveness of a comprehensive approach to melasma treatment, focusing on the use of hardware technologies aimed at dermal remodeling, in combination with topical depigmenting agents, systemic tranexamic acid, and photoprotection. Material and methods. To analyze existing approaches to melasma treatment, a systematic literature review was conducted using PubMed, Scopus, Web of Science, and RSCI databases. Publications published between 2010 and 2025 on the pathogenesis, etiology, and efficacy of topical, systemic, and instrumental treatments for melasma were included. Search keywords included: melasma, hyperpigmentation, laser therapy, topical treatment, tranexamic acid, and dermal remodeling. A prospective study included 100 patients with melasma who underwent combination treatment with hardware-based therapies (picosecond, thulium, and nanosecond lasers, non-ablative fractional laser, and needle X-ray) in combination with topical medications, systemic tranexamic acid, and daily photoprotection. Efficacy was assessed using the MASI, photographic assessment, and recurrence data at 6 months. Results. Literature data support the need for a comprehensive approach. In our sample, the combination of hardware-based therapies with topical and systemic therapy resulted in clinical improvement in 86% of patients, with an average MASI reduction of 45 ± 6%, while the recurrence rate at 6 months was observed in 8.6% of patients. The most pronounced effect was observed in patients receiving a combination of fractional non-ablative laser or needle X-ray with topical melanogenesis blockade and photoprotection. Conclusion. Dermal remodeling using modern laser and radiofrequency technologies in combination with topical and systemic therapy is an effective strategy for melasma, reducing melanocyte activity, decreasing dermal inflammation, and reducing the risk of recurrence.
Source: Effective Pharmacotherapy
Authors: A.R. Nogerov, T.O. Bykovskaya
Institution: Central State Medical Academy
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214975596