{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:38:48Z","timestamp":1792553928686,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pigment Cell Melanoma Res"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Vitiligo and melasma frequently coexist, creating a treatment dilemma, since agents effective for one condition can destabilize the other, and no consensus currently exists on safe management. We conducted a scoping literature review (through June 2023) on treatment of patients with concomitant vitiligo and melasma, followed by a two\u2010round international e\u2010Delphi survey (22 experts from 14 countries; consensus defined as \u2265\u200970% agreement) and a final online consensus meeting. Only one study supported the safe use of oral tranexamic acid for melasma in vitiligo patients. Expert consensus favored prioritizing vitiligo treatment, particularly when active, while incorporating patient's preferences. Targeted phototherapy is suitable for localized facial lesions of vitiligo, and non\u2010facial vitiligo can be treated alongside melasma after covering the face. Topical calcineurin inhibitors, ruxolitinib, tretinoin, corticosteroids, and oral tranexamic acid can be used. Lasers and chemical peels were recommended only with caution by experienced pigment specialists. Until there is enough scientific evidence, hydroquinone would be replaced by other safer cosmetic lightening agents (e.g., niacinamide, ascorbic acid, thiamidol, melasyl), which show comparable efficacy with less theoretical risk. This first international consensus offers practical, patient\u2010centered guidance for managing coexisting vitiligo and melasma, emphasizing individualized, disease\u2010activity\u2010based treatment sequencing.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    PROSPERO reference number: RD42023395586\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Significance<\/jats:italic>\n                    . Depigmenting agents used for melasma inhibit melanogenesis, a mechanism that can further compromise the already\u2010stressed melanocyte populations characteristic of vitiligo. This consensus gives clinicians an expert\u2010informed pathway through a common but understudied comorbidity. It also identifies a clear research gap: controlled, mechanistic comparisons of hydroquinone against newer tyrosinase inhibitors specifically in vitiligo\u2010prone skin are still lacking.\n                  <\/jats:p>","DOI":"10.1111\/pcmr.70125","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:47:45Z","timestamp":1792550865000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Safety of Melasma Treatment in Vitiligo Patients: An International E\u2010Delphi Study"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7791-9141","authenticated-orcid":false,"given":"Marwa","family":"Abdallah","sequence":"first","affiliation":[{"name":"Dermatology, Venereology &amp; Andrology Department Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-4589","authenticated-orcid":false,"given":"Khaled","family":"Ezzedine","sequence":"additional","affiliation":[{"name":"Department of Dermatology H\u00f4pital Henri Mondor and Universit\u00e9 Paris\u2010Est Cr\u00e9teil, EpiDermE\u2014Epidemiology in Dermatology and Evaluation of Therapeutics  Creteil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0797-6570","authenticated-orcid":false,"given":"Thierry","family":"Passeron","sequence":"additional","affiliation":[{"name":"Department of Dermatology, CHU Nice Universit\u00e9 C\u00f4te d'Azur  Nice France"},{"name":"C3M, INSERM U1065 Universit\u00e9 C\u00f4te d'Azur  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5776-1466","authenticated-orcid":false,"given":"Viktoria","family":"Eleftheriadou","sequence":"additional","affiliation":[{"name":"Walsall Healthcare NHS Trust and The Royal Wolverhampton NHS Trust University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1885-6563","authenticated-orcid":false,"given":"Laila","family":"Benzekri","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Ibn Sina University Hospital Mohammed V University  Rabat Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9767-5765","authenticated-orcid":false,"given":"Caio Cesar Silva","family":"de Castro","sequence":"additional","affiliation":[{"name":"Hospital de Dermatologia Sanit\u00e1ria do Paran\u00e1  Piraquara Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5956-4404","authenticated-orcid":false,"given":"Nada","family":"Elbuluk","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1705-2638","authenticated-orcid":false,"given":"Samia","family":"Esmat","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Faculty of Medicine Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-208X","authenticated-orcid":false,"given":"Andrea","family":"Tovar\u2010Garza","sequence":"additional","affiliation":[{"name":"Uniq Dermatology  Monterrey Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-5601","authenticated-orcid":false,"given":"Iltefat H.","family":"Hamzavi","sequence":"additional","affiliation":[{"name":"Department of Dermatology Henry Ford Hospital  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2711-3112","authenticated-orcid":false,"given":"Hyun Jeong","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Dermatology, St. Vincent's Hospital, College of Medicine The Catholic University of Korea  Suwon Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3899-5250","authenticated-orcid":false,"given":"Prasad","family":"Kumarasinghe","sequence":"additional","affiliation":[{"name":"University of Western Australia  Crawley Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-8519","authenticated-orcid":false,"given":"Jung Min","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Dermatology The Catholic University of Korea  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasneem F.","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Dermatology Henry Ford Hospital  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-0815","authenticated-orcid":false,"given":"Davinder","family":"Parsad","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology &amp; Leprology Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-4813","authenticated-orcid":false,"given":"Noufal","family":"Raboobee","sequence":"additional","affiliation":[{"name":"Department of Dermatology Westville Hospital  Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9747-1882","authenticated-orcid":false,"given":"Michelle","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Chroma Dermatology, Pigment and Skin of Colour Centre  Wheelers Hill Victoria Australia"},{"name":"Department of Dermatology The Royal Children's Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1139-0908","authenticated-orcid":false,"given":"Julien","family":"Seneschal","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint\u2010Andr\u00e9, ImmunoConcept, CNRS UMR 5164 Bordeaux University  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5980-5319","authenticated-orcid":false,"given":"Steven","family":"Thng","sequence":"additional","affiliation":[{"name":"Skin Research Institute of Singapore, ASTAR  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3249-8195","authenticated-orcid":false,"given":"Nanja Van","family":"Geel","sequence":"additional","affiliation":[{"name":"Department of Dermatology Ghent University Hospital  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1421-1493","authenticated-orcid":false,"given":"Albert","family":"Wolkerstorfer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam Institute for Infection and Immunity University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5879-5611","authenticated-orcid":false,"given":"Mahy","family":"El\u2010Bassiouny","sequence":"additional","affiliation":[{"name":"Dermatology, Venereology &amp; Andrology Department Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"66","key":"e_1_2_9_2_1","first-page":"114","article-title":"Assessment and Comparison of Quality of Life in Patients With Melasma and Vitiligo","volume":"17","author":"Amatya B.","year":"2019","journal-title":"Kathmandu University Medical Journal (KUMJ)"},{"issue":"8","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1016\/j.jid.2019.02.013","article-title":"Effective Tyrosinase Inhibition by Thiamidol Results in Significant Improvement of Mild to Moderate Melasma","volume":"139","author":"Arrowitz C.","year":"2019","journal-title":"Journal of Investigative Dermatology"},{"issue":"8","key":"e_1_2_9_4_1","article-title":"Diffuse Facial Leukoderma Secondary to Localized Use of Hydroquinone","volume":"16","author":"Artz C.","year":"2024","journal-title":"Cureus"},{"issue":"9","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"914","DOI":"10.2340\/00015555-2994","article-title":"Disfiguring Leukoderma Caused by Banned Cosmetics: A Quiz","volume":"98","author":"Atzori L.","year":"2018","journal-title":"Acta Dermato\u2010Venereologica"},{"issue":"6","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1159\/000506103","article-title":"Vitiligo: A Review","volume":"236","author":"Bergqvist C.","year":"2020","journal-title":"Dermatology"},{"issue":"12","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1111\/jdv.19455","article-title":"Efficacy and Safety of a Novel Triple Combination Cream Compared to Kligman's Trio for Melasma: A 24\u2010Week Double\u2010Blind Prospective Randomized Controlled Trial","volume":"37","author":"Bertold C.","year":"2023","journal-title":"Journal of the European Academy of Dermatology and Venereology: JEADV"},{"issue":"5","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.1111\/dth.15047","article-title":"Feasibility of Oral Tranexamic Acid for Vitiligo Patients With Melasma","volume":"34","author":"Chiang P. H.","year":"2021","journal-title":"Dermatologic Therapy"},{"issue":"5","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.4103\/ijdvl.IJDVL_209_17","article-title":"Chemical Leukoderma Due to Hydroquinone: An Unusual Phenomenon","volume":"85","author":"Das A.","year":"2019","journal-title":"Indian Journal of Dermatology, Venereology and Leprology"},{"issue":"1","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/bjd.20596","article-title":"British Association of Dermatologists Guidelines for the Management of People With Vitiligo 2021","volume":"186","author":"Eleftheriadou V.","year":"2022","journal-title":"British Journal of Dermatology"},{"issue":"2","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5021\/ad.2020.32.2.101","article-title":"Exploratory Study of Epidermis, Basement Membrane Zone, Upper Dermis Alterations and Wnt Pathway Activation in Melasma Compared to Adjacent and Retroauricular Skin","volume":"32","author":"Esp\u00f3sito A. C. C.","year":"2020","journal-title":"Annals of Dermatology"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1600-0536.1982.tb04219.x","article-title":"Leukoderma From Bleaching Cream Containing 2% Hydroquinone","volume":"8","author":"Fisher A. A.","year":"1982","journal-title":"Contact Dermatitis"},{"issue":"5","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00403-020-02068-z","article-title":"Tacrolimus (FK506) Ointment Combined With Nb\u2010UVB Could Activate Both Hair Follicle (HF) and Dermal Melanocyte Precursors in Vitiligo: The First Histopathological and Clinical Study","volume":"313","author":"Gauthier Y.","year":"2021","journal-title":"Archives of Dermatological Research"},{"issue":"5","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1590\/abd1806-4841.20143063","article-title":"Melasma: A Clinical and Epidemiological Review","volume":"89","author":"Handel A. 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C.","year":"1989","journal-title":"Contact Dermatitis"},{"issue":"9","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1248\/bpb.26.1365","article-title":"Intradermal Concentration of Hydroquinone After Application of Hydroquinone Ointments Is Higher Than Its Cytotoxic Concentration","volume":"26","author":"Matsubayashi T.","year":"2003","journal-title":"Biological & Pharmaceutical Bulletin"},{"issue":"8","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1111\/jdv.19910","article-title":"A Bayesian Network Meta\u2010Analysis of 14 Molecules Inhibiting UV Daylight\u2010Induced Pigmentation","volume":"38","author":"Muller B.","year":"2024","journal-title":"Journal of the European Academy of Dermatology and Venereology: JEADV"},{"issue":"3","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s13555-017-0194-1","article-title":"Melasma: An Up\u2010to\u2010Date Comprehensive Review","volume":"7","author":"Ogbechie\u2010Godec O. A.","year":"2017","journal-title":"Dermatology and Therapy"},{"issue":"11","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1111\/j.1468-3083.2009.03295.x","article-title":"A Global Survey of the Role of Ultraviolet Radiation and Hormonal Influences in the Development of Melasma","volume":"23","author":"Ortonne J. P.","year":"2009","journal-title":"Journal of the European Academy of Dermatology and Venereology: JEADV"},{"issue":"12","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"3352","DOI":"10.1016\/j.jid.2022.05.1093","article-title":"Addition of Narrow\u2010Band UVB Phototherapy to Ruxolitinib Cream in Patients With Vitiligo","volume":"142","author":"Pandya A. G.","year":"2022","journal-title":"Journal of Investigative Dermatology"},{"issue":"8","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1007\/s00204-019-02506-6","article-title":"Keratinocyte\u2010Derived IL\u201036\u03b3 Plays a Role in Hydroquinone\u2010Induced Chemical Leukoderma Through Inhibition of Melanogenesis in Human Epidermal Melanocytes","volume":"93","author":"Pyo J. J.","year":"2019","journal-title":"Archives of Toxicology"},{"issue":"3","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","DOI":"10.1111\/jocd.70097","article-title":"Evaluation of the Efficacy of a Serum Containing Niacinamide, Tranexamic Acid, Vitamin C, and Hydroxy Acid Compared to 4% Hydroquinone in the Management of Melasma","volume":"24","author":"Rocio J.","year":"2025","journal-title":"Journal of Cosmetic Dermatology"},{"issue":"16","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1056\/NEJMoa2118828","article-title":"Two Phase 3, Randomized, Controlled Trials of Ruxolitinib Cream for Vitiligo","volume":"387","author":"Rosmarin D.","year":"2022","journal-title":"New England Journal of Medicine"},{"issue":"11","key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1111\/jdv.19450","article-title":"Worldwide Expert Recommendations for the Diagnosis and Management of Vitiligo: Position Statement From the International Vitiligo Task Force\u2010Part 2: Specific Treatment Recommendations","volume":"37","author":"Seneschal J.","year":"2023","journal-title":"Journal of the European Academy of Dermatology and Venereology: JEADV"},{"issue":"2","key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.2165\/11537120-000000000-00000","article-title":"Response to Narrow\u2010Band UVB\u2014Vitiligo\u2010Melasma Versus Vitiligo: A Comparative Study","volume":"12","author":"Sharma P.","year":"2011","journal-title":"American Journal of Clinical Dermatology"},{"issue":"4","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jaad.2010.12.046","article-title":"Melasma: A Comprehensive Update: Part I","volume":"65","author":"Sheth V. M.","year":"2011","journal-title":"Journal of the American Academy of Dermatology"},{"issue":"7","key":"e_1_2_9_29_1","doi-asserted-by":"crossref","DOI":"10.1007\/s00403-024-02990-6","article-title":"An Update on the Safety of Hydroquinone","volume":"316","author":"Shivaram K.","year":"2024","journal-title":"Archives of Dermatological Research"},{"issue":"6","key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.4103\/idoj.IDOJ_6_17","article-title":"Dermoscopy of Melasma","volume":"8","author":"Sonthalia S.","year":"2017","journal-title":"Indian Dermatology Online Journal"},{"issue":"5","key":"e_1_2_9_31_1","doi-asserted-by":"crossref","first-page":"272","DOI":"10.3109\/09546630903341945","article-title":"Hydroquinone for Skin Lightening: Safety Profile, Duration of Use and When Should We Stop?","volume":"21","author":"Tse T. W.","year":"2010","journal-title":"Journal of Dermatological Treatment"},{"key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1111\/jdv.15604","article-title":"Clinical Visible Signs of Disease Activity in Vitiligo: A Systematic Review and Meta\u2010Analysis","volume":"33","author":"Geel N.","year":"2019","journal-title":"Journal of the European Academy of Dermatology and Venereology"}],"container-title":["Pigment Cell &amp; Melanoma Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pcmr.70125","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pcmr.70125","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pcmr.70125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:47:50Z","timestamp":1792550870000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pcmr.70125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/pcmr.70125"],"URL":"https:\/\/doi.org\/10.1111\/pcmr.70125","archive":["Portico"],"relation":{},"ISSN":["1755-1471","1755-148X"],"issn-type":[{"value":"1755-1471","type":"print"},{"value":"1755-148X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2026-01-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70125"}}