Here, the Indian dermatologists panel has graded
the results of safety and efficacy of various
melasma therapies from clinical trials conducted
worldwide (Table 7) applying the quality and level
of evidence based on the US preventive services
task force on health care (Table 8). Focus on the
efficacy as well as AEs particular to the major skin
types of Indian population, using evidence from
clinical trials and physicians’ experience in the
clinic, has directed the selection process for each
recommended therapy. Using these guidelines, a
much needed algorithm specific to melasma in
India has been evolved and will assist physician’s
decision on melasma treatment, disease
management, and optimal outcome. We have
also brought to attention some practices in
treatment of melasma, for example, prolonged
use of mometasone-based triple combination and
prognosis indicators that have negative
connotations. The key therapy recommended is
fluorinated steroid containing 2–4% HQ-based
triple combination for first-line therapy, with
additional selective peels if required in secondline therapy. Lasers are a last resort