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IADVL-SIG PIGMENTARY DISORDERS SYMPOSIUM ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 6  |  Page : 406-442

Evidence-based review, grade of recommendation, and suggested treatment recommendations for melasma


1 Department of Dermatology, Dr B C Roy Post Graduate Institute of Pediatric Science, Kolkata, West Bengal, India
2 Department of Dermatology, R G Kar Medical College, Kolkata, West Bengal, India
3 Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India
4 Consultant Dermatologist, Siliguri, India
5 Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
6 Department of Dermatology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
7 Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
8 Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
9 ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India

Correspondence Address:
Nilendu Sarma
P N Colony, Sapui Para, Bally, Howrah, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_187_17

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Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.


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