Melasma Treatment Guidelines

Current Standard of Care for Melasma

The standard of care for melasma includes strict sun protection, topical therapies, oral tranexamic acid, and procedural treatments like platelet-rich plasma injections or microneedling in refractory cases 2
Compounded creams containing hydroquinone and/or other depigmenting agents are part of the established treatment regimen for melasma 2
Laser therapy combined with sun protection is also part of the standard treatment plan for melasma 2
The American Academy of Dermatology recommends strict sun protection and topical therapies as first-line treatments for melasma 1

Clascoterone is a topical antiandrogen that directly binds to androgen receptors and inhibits androgen-mediated lipid and inflammatory cytokine synthesis from sebocytes - a mechanism specific to acne treatment 1
The American Academy of Dermatology conditionally recommends clascoterone only for acne vulgaris treatment, not for melasma 1, 3
Melasma pathophysiology involves melanocyte dysfunction rather than androgen-mediated processes, making clascoterone's mechanism of action irrelevant to melasma treatment 2

If additional treatment is needed, platelet-rich plasma (PRP) injections have shown significant improvement in melasma within 6 weeks as measured by modified Melasma Area and Severity Index (mMASI) scores 4, 5
PRP combined with oral tranexamic acid demonstrates higher efficacy compared to tranexamic acid alone with lower recurrence rates 5
Intradermal PRP injections have shown higher efficacy compared to intradermal tranexamic acid injections with similar side effect profiles 5
Microneedling may be more effective than intradermal PRP injections for melasma treatment in some patients 4