For all topical agents, continued treatment and use of medications is necessary as pigmentation may recur following treatment cessation. Future large RCTs with control arms using standard-of-care treatments (ie, HQ or TC) are necessary to assess the relative risks and benefits of a novel agent. Current topical treatments mostly inhibit melanin formation and transfer, but do not target the vascular components of melasma, inflammation, or underlying disease etiology. We believe that synergetic combination approaches are likely to have greater efficacy than stand-alone treatments. Future mechanistic research on the underlying etiology of melasma may facilitate the development of targeted approaches.
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