Background: Melasma, an acquired hyperpigmentation disorder, affects individuals of all ethnicities. Its multifactorial aetiology, high recurrence rates and psychosocial impact complicate management and necessitate comprehensive, evidence-based recommendations.
Objectives: The objective was to develop an international consensus on the diagnosis and management of melasma by synthesizing expert opinions and the latest scientific evidence.
Methods: This consensus was developed using a modified Delphi approach. A core group of two senior dermatologists who were experts in pigmentary disorders guided the process, and a diverse panel of 38 dermatologists with a special interest in pigmentary disorders from 11 countries (Australia, Brazil, France, India, Italy, Mexico, Philippines, South Africa, South Korea, Taiwan and the USA) participated in three rounds of surveys and discussions, under the aegis of the Pigmentary Disorders Society (PDS). A literature search of articles published between 2014 and 2024 identified key studies that were graded using the Oxford levels of evidence (2009). Consensus statements were drafted, refined and finalized based on expert feedback. Responses were assessed using a 5-point Likert scale, with predefined thresholds for high (≥75%), moderate (55%-74%) and low (<55%) agreement.
Results: The consensus development process started with 34 statements, and at the end of the third round of the Delphi process, 21, 4 and 1 statement reached high, moderate and low consensus, respectively. Key recommendations highlighted photoprotection with broad-spectrum sunscreens as essential, regulated and supervised use of hydroquinone-based triple combination creams as the gold standard, and alternatives such as topical azelaic acid, kojic acid and oral tranexamic acid. Adjunctive procedural therapies, such as chemical peels and microneedling, were suggested to enhance topical efficacy, while lasers were reserved for refractory cases.
Conclusions: These recommendations aim to improve the outcomes of melasma patients globally by integrating expert opinion and evidence-based strategies. Future research should focus on evaluating emerging therapies and optimizing long-term maintenance strategies.
Keywords: consensus; dermatology; disease management; hyperpigmentation; melanosis.
Melasma is a common skin condition that causes dark patches on the face. It affects people of all skin types and can have a major impact on confidence and quality of life. Treating melasma is challenging because it has many causes, tends to come back after treatment, and often requires a long‐term plan. To help improve care, a group of international experts worked together with the Pigmentary Disorders Society (PDS) to develop clear recommendations for how to diagnose and manage melasma. The group included 40 dermatologists from 11 countries, and their advice was based on both published research and their clinical experience. The recommendations were created using a structured process to reach agreement on best practices. The experts agreed that daily sun protection with broad‐spectrum sunscreen is essential for everyone with melasma. The most effective treatment remains hydroquinone‐based triple combination creams, but these should only be used under medical supervision. Other options include topical agents such as azelaic acid and kojic acid, as well as oral tranexamic acid. Procedures like chemical peels and microneedling can be used alongside creams to improve results, while lasers should mainly be considered for patients who do not respond to other treatments. These international recommendations aim to help doctors provide more effective and consistent care for patients with melasma around the world. Further studies are needed to better understand new treatments and strategies for preventing relapses.
© 2025 European Academy of Dermatology and Venereology.