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Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects, and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post\u2010inflammatory hyperpigmentation, particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA\u2010approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma.<\/jats:p>","DOI":"10.1111\/jocd.15242","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T04:29:42Z","timestamp":1658291382000},"page":"3707-3728","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Medical therapies for melasma"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0537-4066","authenticated-orcid":false,"given":"Vikram K.","family":"Mahajan","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology &amp; Leprosy Dr. Rajendra Prasad Government Medical College Kangra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9455-4025","authenticated-orcid":false,"given":"Anant","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Dr. DY Patil Medical College Navi Mumbai 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