Abstract

Objectives: This review explores the latest treatment strategies for managing melasma, focusing on advancements in topical and oral agents, energy-based devices, bio-regenerative therapies, and combination approaches. By evaluating these emerging therapies, the review aims to assess their effectiveness, safety, and potential for improving clinical outcomes, while emphasizing strategies to minimize the risk of recurrence, which remains a significant challenge in the long-term management of melasma. Introduction: Melasma is a chronic pigmentary disorder, most common in individuals with darker skin tones, and is caused by a combination of factors like genetics, hormonal imbalances, and sun exposure. Due to its complex nature, melasma has a high recurrence rate, and complete cure is not possible, making long-term management the main goal. Conventional treatments, such as hydroquinone and sunscreen offer limited success and unpredictable results. Recently, newer therapies have shown promise in treating stubborn melasma by targeting different components of its etiology, including pigmentation, vascular fac Materials / method: This review compiles and analyzes recent studies on emerging therapies for melasma. It focuses on novel topical treatments like tranexamic acid and cysteamine, as well as advancements in laser technologies including laser toning, fractional lasers, picosecond lasers, and pulse-type MNRF. Additionally, regenerative therapies such as exosomes, PDRN, and PDLLA are explored. Studies on combination therapies that integrate these approaches were reviewed to determine the most effective treatment protocols for improving patient outcomes in melasma management. Results: Novel topical agents like cysteamine have shown significant improvements in reducing pigmentation with fewer side effects than traditional treatments. Low-fluence Q-switched laser toning and picosecond lasers have also been more effective in treating melasma, minimizing risks of post-inflammatory hyperpigmentation and hypopigmentation. Addressing solar elastosis has led to better outcomes in resistant cases. Studies suggest that combining these treatments enhances overall results, offering longer-lasting benefits and reducing the recurrence of melasma. Conclusion: Emerging treatments in melasma, including advanced topical agents, energy-based devices, and bio-regenerative therapies, offer significant improvements over traditional methods. Combination approaches, which target multiple aspects of melasma like pigmentation, vascular issues, and photoaging, have shown the most success. While these innovations provide hope for better outcomes, recurrence remains a challenge, and further research is needed to enhance treatment protocols and long-term effectiveness.