Treatment Of Melasma Research Articles

Research situation, hot spots, and global trends of melasma therapy: Bibliometric insights and visual analysis from 2000 to 2023.

Melasma is a prevalent pigmented disease, yet its pathogenesis remains unclear, posing challenges for effective treatment. Bibliometric analysis, a novel approach to literature research, offers the opportunity to evaluate research trends through qualitative and quantitative methods. This study utilizes bibliometric methods to analyze the existing literature on melasma treatment, examining influential publications, institutions, countries, and authors through statistical analysis. In order to retrieve manuscripts related to the topic of melasma treatment, we conducted a search using the search formula: (TS = (melasma or Chloasma or "mask of pregnancy")) AND TS = (treatment or therapy). We searched through the Web of Science Core Collection database, covering publications from 2000 to 2023. VOSviewer, CiteSpace and the Bibliometric online site (https://bibliometric.com/app) were used to conduct this bibliometric analysis. Our analysis focused on various factors including publications, authors co-authorship, institutions, countries, citation analysis, keywords co-occurrence, references co-citation and journal co-citation. A total of 943 articles and 200 reviews were published between 2000 and 2023, accumulating a total of 8628 citations. The average number of citations per item was 18.85, and the average number of citations per year was 292.69. The most prolific author, Sungeun Chang, contributed a total of 9 articles. Cario University emerged as the top research institution. The United States led in terms of article publications with a count of 276. In the past 5 years, the research trends in this field have primarily focused on tranexamic acid and epidermal melasma, as indicated by the burst analysis of publications and keywords. The United States continues to lead in terms of institutions and research output. The current emphasis is on the meticulous implementation of tranexamic acid and laser therapy. It is crucial to foster enhanced collaboration among countries, institutions, and authors to facilitate improved research.

Assessing the efficacy of oral tranexamic acid as an adjuvant to triple combination topical treatment in melasma: a meta-analysis of randomized controlled trials

Abstract Melasma is a skin pigmentation disorder that lacks consistent treatment success, despite various methods used. Tranexamic acid (TXA) has shown hypopigmentation properties, but whether its administration should be combined with standard treatment has yet to be clarified. We aimed to perform an investigation of the effectiveness and safety of oral TXA as an adjuvant to triple combination cream (TCC) treatment in melasma. We searched PubMed, Embase and Cochrane (CENTRAL) for studies that compared TCC + adjuvant TXA to TCC treatment alone in patients with melasma. Outcomes of interest included change from the baseline Melasma Area and Severity Index (MASI) score, recurrence of melasma and adverse events. Statistical analysis was performed using R Studio 4.3.2. Four trials involving 490 patients were included. In the pooled analysis, the decrease from baseline in MASI score [mean difference –3.10, 95% confidence interval (CI) –5.85 to –0.35] was significantly higher in patients treated with oral TXA as an adjuvant to TCC compared with TCC alone. Melasma recurrence [risk ratio (RR) 0.28; 95% CI 0.16–0.49] was significantly lower in the group treated with TCC and TXA. Regarding erythema (RR 0.63, 95% CI 0.34–1.17) and burning (RR 0.59, 95% CI 0.30–1.17), no statistically significant difference was found. This meta-analysis demonstrated statistically significant benefits of TCC + TXA combination treatment compared with TCC alone. Furthermore, the results suggest that the addition of TXA to TCC treatment may reduce melasma recurrence.

Comparative study of melasma in patients before and after treatment based on lipomics

BackgroundSkin barrier alterations play a crucial function in melasma development. Past researches have demonstrated variations in lipid content between the epidermis of melasma lesions and normal tissues, along with the varied expression of lipid-related genes in melasma. This study aimed to analyze the lipidome profiles of skin surface lipids (SSL) in patients with melasma before and after treatment to understand associated abnormalities.MethodsMelasma was treated with tranexamic acid orally and hydroquinone cream topically. Disease was assessed using the Melasma Area and Severity Index (MASI), and the impact to life was evaluated with Melasma Quality of Life (MELASQoL) score. Epidermal melanin particles were observed using reflection confocal microscopy (RCM), whereas epidermal pigment and blood vessel morphology were observed using dermoscopy, and SSL samples were collected. Specific information regarding alterations in lipid composition was obtained through multivariate analysis of the liquid chromatography-mass spectrometry data.ResultsAfter treatment, patients with melasma exhibited decreased MASI and MELASQoL scores (P < 0.001); RCM revealed reduced melanin content in the lesions, and dermoscopy revealed fewer blood vessels. Fifteen lipid subclasses and 382 lipid molecules were identified using lipidomic assays. The expression levels of total lipids, phosphatidylcholine, and phosphatidylethanolamine in the melasma lesions decreased after treatment (P < 0.05).ConclusionThis study revealed alterations in the SSL composition after effective melasma treatment, suggesting a compensatory role for lipids in melasma barrier function. The mechanism involving SSL and the lipid barrier, which influences melasma’s occurrence, needs further elucidation.

Hyaluronic acid dissolving microneedle patch loaded with tranexamic acid for melasma treatment

Melasma is an acquired hypermelanotic condition characterized by the presence of irregular light-to-dark brown macules that primarily manifest on the sun-exposed areas of the skin, particularly the face. The management of melasma poses significant challenges, as it is often recalcitrant to treatment and tends to recur despite successful treatment. In this study, we explored a safe, easy, and effective melasma treatment strategy. A hyaluronic acid (HA)-based microneedle (MN) patch loaded with tranexamic acid (TXA) was designed to deliver the necessary medication for melasma treatment. The MN patch features uniform needles with adequate mechanical strength and effective penetration and solubility in the skin without cytotoxicity. Remarkably, these MNs substantially reduce the thickness of the epidermis of melasma mice, curtail melanin production, and diminish dopachrome tautomerase (DCT) expression.

High power and high efficiency yellow laser in Dy3+-doped single-mode double-clad structured waterproof fluoro-aluminate glass fiber

We demonstrated a single-mode yellow fiber laser using a Dy3+-doped single-mode double-clad structured weatherproof fluoro-aluminate glass fiber (Dy3+:SM-DC-WPFGF) and a 450-nm GaN laser diode (LD) as the excitation light. The power of 445 mW and the slope efficiency of 51.2% were achieved for the single-mode yellow fiber laser. The power level was approximately 20 times higher than our previous result due to improved efficiency of the focusing optics and increased Dy3+ doping concentration (10,000 ppm) in the fiber core. This yellow fiber laser shows particular promise for use in the medical field, e.g., for the treatment of melasma and telangiectasia.

Comparative Effectiveness of 20% Azelaic Acid with 1064-nm Nd:YAG Picosecond Laser vs Azelaic Acid Alone for Melasma Treatment in Thai Female Patients: A Split-Face Study

Melasma is one of the most concerning pigmented skin conditions, especially in females. It can be influenced by sunlight, occupation, gender, and drug use, which can aggravate the disease. This split-face clinical trial assesses the effectiveness of picosecond laser in melasma treatment combined with topical azelaic acid compared with azelaic alone. The primary outcome of this study is the Hemi-MASI score, while the secondary outcome is demographic data, physicians' global assessment, patient satisfaction score, and adverse events. The study recruited twenty Thai females aged between 18 and 65 diagnosed with bilateral symmetrical malar-type melasma. The patients were treated with low fluence 1064-nm Nd:YAG picosecond laser three sessions every two weeks combined with topical azelaic acid twice daily on the right side of the face, whereas the left side was treated with topical azelaic acid twice daily alone for 16 weeks. The mean Hemi-MASI decrease is 3.52%, 9.38%, and 19.94% on the combination side, while there are 1.93%, 7.89%, and 16.73% at the 8th, 12th, and 16th, respectively in the topical azelaic alone side. There were no severe side effects from both picosecond laser and azelaic acid, and they can be relieved without treatment. Thus, the overall clinical result demonstrates the improvement as the patient satisfaction score is satisfied. Still, the mean Hemi-MASI score between the two sides is not statistically significantly different (p&gt;0.05). In conclusion, combining the picosecond laser with azelaic acid alone in melasma treatment results in a better overall general outcome than the azelaic alone.

Efficacy and safety of mesotherapy with tranexamic acid versus vitamin C in the treatment of melasma: A meta-analysis and systemic review.

The exact pathogenesis of melasma is not yet known, and its treatment remains challenging. Mesotherapy with tranexamic acid (TXA) and vitamin C was both reported to have certain effects on melasma. In spite of that several articles have compared the efficacy and safety of the two drugs on melasma, most of them were clinical study with small sample size. To evaluate the efficacy and safety of mesotherapy with TXA versus vitamin C in treating melasma through meta-analysis and systemic review. The authors searched PubMed, Web of Science, Springer, and ScienceDirect for studies that compared mesotherapy with TXA versus vitamin C as a treatment for melasma. Primary outcomes were change in melasma area and severity index (MASI) before and after the treatment. Finally, five studies with a total of 127 patients were included in the systematic review. There was no statistic difference in the change in MASI score between the TXA and vitamin C groups (mean difference, 0.16; 95% CI, -0.79 to 1.11). Mesotherapy with both TXA and vitamin C is safe and effective in the treatment of melasma.

Combining large-spot low-fluence 1064-nm and fractional 1064-nm picosecond lasers for promoting protective melanosome autophagy via the PI3K/Akt/mTOR signalling pathway for the treatment of melasma.

Melasma is a common condition of hyperpigmented facial skin. Picosecond lasers are reported to be effective for the treatment of melasma. We aimed to identify the most effective therapeutic mode and elucidate the potential molecular mechanisms of picosecond lasers for the treatment of melasma. Female Kunming mice with melasma-like conditions were treated using four different picosecond laser modes. Concurrently, invitro experiments were conducted to assess changes in melanin and autophagy in mouse melanoma B16-F10 cells treated with these laser modes. Changes in melanin in mouse skin were detected via Fontana-Masson staining, and melanin particles were evaluated in B16-F10 cells. Real-time polymerase chain reaction and western blotting were used to analyse the expression levels of melanosome and autophagy-related messenger ribonucleic acid (mRNA) and proteins. A combination of large-spot low-fluence 1064-nm and fractional 1064-nm picosecond lasers resulted insignificant decreases in melanin as well as in mRNA and protein expression of melanin-synthesizing enzymes (TYR, TRP-1 and MITF). This combination also led to increased expression of the autophagy-related proteins, Beclin1 and ATG5, with a marked decrease in p62 expression. Intervention with the PI3K activator, 740 Y-P, increased TYR, TRP-1, MITF, p-PI3K, p-AKT, p-mTOR and p62 expression but decreased the expression of LC3, ATG5 and Beclin1. A combination of large-spot low-fluence 1064-nm and fractional 1064-nm picosecond lasers proved more effective and safer. It inhibits melanin production, downregulates the PI3K/AKT/mTOR pathway, enhances melanocyte autophagy and accelerates melanin metabolism, thereby reducing melanin content.

Definition of refractory melasma and its treatment: a review.

Although patients with refractory melasma have been treated using various methods, there is still no precise definition or summary of the therapies. To define refractory melasma and conduct a review of the treatments, we searched for relevant publications in PubMed, Web of Science, and the Cochrane Library, and a total of 35 references were obtained. Refractory melasma can be roughly defined as an ineffective treatment for melasma, including topical bleaching agents, chemical peels, laser therapy, microdermabrasion for more than six months, or chemical peels treated more than six times. Meanwhile, physicians should be careful when treating patients withdarker skin and dermal or mixed types of melasma since these individuals do not respond well to treatment. Lasers combined with other methods, especially different types of lasers or topical agents, are considered more effective than monotherapy. Oral tranexamic acid (TXA) is a prospective cure for refractory melasma. Other methods include a combination of chemical peels, microneedling, or injections with additional therapies. In conclusion, we were able to provide a rough definition of refractory melasma and list the available therapies. According to the literature, the most prevalent treatment is laser combination therapy. However, laser treatment should be considered only after topical agents and chemical peeling have failed. Considering its side effects, efficacy, and safety, oral TXA may be a better option, but more research is needed to make a firm conclusion. Moreover, maintenance therapy is required after treatment.

Comparison Study Between Chemical Peeling with 70% Glycolic Acid and Intradermal Tranexamic Acid for the Treatment of Melasma

Objective: To compare the efficacy of 70% Glycolic acid peeling with Tranexamic acid mesotherapy in treating melasma. Study Design: Quasi-experimental study Place and Duration of Study: Department of Dermatology, CMH-Abbottabad Pakistan, Jun to Nov 2021. Methodology: The 54 patients aged 20-50 years were enrolled and randomly assigned into two groups. In Group-A, 27 patients prescribed 70% Glycolic acid every two weeks for 12 weeks (6 sessions) and in Group-B, 27 patients injected every week for 12 weeks (12 sessions) with Intradermal Tranexamic acid (4mg/ml). All patients had a clinical examination using the mMASI scale. On follow-up, evaluation was carried out on the 1st, sixth, and 12th weeks. Results: The majority of 35(65%) patients had mild MASI scores. The paired t-test results of Group A and Group B were both significant, while the post-treatment mean of Group A and B was insignificant. Conclusion: The study concludes that Glycolic acid and TXA are equally efficient in treating melasma. Moreover, Tranexamic acid reduced the recurrence of melasma, but topical application of Glycolic acid showed more compliance.

Effect of the use of tranexamic acid in the treatment of melasma

Effect of the use of tranexamic acid in the treatment of melasma

A comparison of the effectiveness of intralesional tranexamic acid against platelet-rich plasma in the treatment of melasma

Background: Melasma, derived from the Greek word "melas" meaning "black", manifests as an acquired, more or less symmetrical hypermelanosis of sun-exposed skin. This study aimed to compare and evaluate the efficacy and safety of intradermal injection of tranexamic acid and platelet-rich plasma in treating various types of melasma. Methods: Conducted from June 2022 to December 2023 at the outpatient department of dermatology, Sri Lakshmi Narayana institute of medical sciences, Puducherry, this split-face prospective study involved 40 melasma cases. Tranexamic acid (4 mg/ml) was intradermally injected into the right side of the face, while PRP was injected into the left side. Improvement was assessed using the modified Melasma area severity index (MASI) grading system and dermoscopy, measuring disease severity and percentage of improvement before and after therapy on both sides of the face. Results: The study comprised predominantly females (80%) aged 20 to 30 years (50%), followed by those aged 30 to 40 years (35%). Most cases (93%) exhibited a gradual onset, with centrofacial (52.5%) and malar (37.5%) patterns being predominant. Mixed pattern (67.5%) was common. Pre-treatment mean MASI scores for tranexamic acid and PRP sides were 7.54 and 6.92, respectively, with post-treatment scores of 4.6 and 2.83, respectively. Conclusions: Intradermal PRP demonstrated significantly superior efficacy over intradermal tranexamic acid in managing melasma, particularly in the longer term. Thus, PRP, coupled with good compliance, may substantially reduce the disease burden compared to conventional tranexamic acid treatment.

Enhancing Tranexamic Acid Penetration through AQP-3 Protein Triggering via ZIF-8 Encapsulation for Melasma and Rosacea Therapy.

The systemic use of tranexamic acid (TA) as an oral drug can bring adverse reactions, while intradermal injection leads to pain and a risk of infection. Moreover, it is difficult for highly hydrophilic TA to penetrate the skin barrier that contains lots of hydrophobic lipid compounds, which poses enormous restrictions on its topical application. Current transdermal TA delivery strategies are suffering from low drug load rates, plus their synthesis complexity, time-consumption, etc. adding to the difficulty of TA topical application in clinical therapeutics. To increase the penetration of TA, a novel approach using TA-loaded ZIF-8 (TA@ZIF-8) is developed. The encapsulation efficiency of TA@ZIF-8 reaches ≈25% through physical adsorption and chemical bonding of TA indicates by theoretical simulation and the improved TA penetration is elevated through activating the aquaporin-3 (AQP-3) protein. Additionally, in vivo and in vitro experiments demonstrate the preponderance of TA@ZIF-8 for penetration ability and the advantages in intracellular uptake, minor cytotoxicity, and inhibition of melanogenesis and inflammatory factors. Moreover, clinical trials demonstrate the safety and efficacy of TA@ZIF-8 in the treatment of melasma and rosacea. This work presents a potential topical application of TA, free from the safety concerns associated with systemic drug administration.

755-nm picosecond laser plus topical 20% azelaic acid compared to topical 20% azelaic acid alone for the treatment of melasma: a randomized, split-face and controlled trial.

Melasma remains a refractory skin condition that needs to be actively explored. Azelaic acid has been used for decades as a topical agent to improve melasma through multiple mechanisms, however, there is a lack of research on its combination with laser therapy. This study evaluated the effectiveness of isolated treatment with topical 20% azelaic acid and its combination with 755-nm picosecond laser in facial melasma patients. A randomized, evaluator-blinded, controlled study was conducted on 30 subjects with facial melasma in a single center from October 2021 to April 2022. All subjects received topical 20% azelaic acid cream (AA) for 24 weeks, and after 4 weeks, a hemiface was randomly assigned to receive 755-nm picosecond (PS) laser therapy once every 4 weeks for 3 treatments. Treatment efficacy was determined by mMASI score evaluations, dermoscopic assessment, reflectance confocal microscopy (RCM) assessments and patient's satisfaction assessments (PSA). Treatment with 20% azelaic acid, with or without picosecond laser therapy, significantly reduced the hemi-mMASI score (P < 0.0001) and resulted in higher patient satisfaction. Improvements in dermoscopic and RCM assessments were observed in both sides of the face over time, with no difference between the two sides. RCM exhibited better dentritic cell improvement in the combined treatment side. No patients had serious adverse effects at the end of treatment or during the follow-up period. The additional use of picosecond laser therapy showed no clinical difference except for subtle differences detected by RCM assessments.The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100051294; 18 September 2021).

Topical isoniazid as a novel treatment for melasma: A randomized, double-blind, vehicle-controlled clinical trial.

Melasma is a chronic hyperpigmentation disorder, and its treatment poses a challenge to dermatologists due to its chronicity and resistance to conventional therapies. Oral isoniazid is used for the treatment of tuberculosis. One of us had previously showed that topical isoniazid exerts a strong depigmenting action in animal models. In this clinical trial, we assessed the therapeutic effect of topical isoniazid on melasma. Twenty female patients suffering from epidermal melasma were enrolled and divided equally into two groups. The treatment group received topical isoniazid 10%, and the control group received the cold cream vehicle as the placebo. All participants were advised to avoid sunlight and used SPF 50 sunscreen. Patients applied topical agents once daily at night for 3 months. The melanin and erythema indices were measured by colorimetric evaluations at baseline and after 4, 8, and 12 weeks of treatment. At these time points, the (mMASI) score was also determined, as was the subjective evaluation through Melasma Quality of Life Scale (MELASQOL) scores. Blood tests were performed to evaluate CBC and the liver enzymes. All patients completed the 12-week study. In the treatment group, a significant decrease in melanin index from 63.77 ± 6.27 at baseline to 55.92 ± 5.79 was recorded (p = 0.001). Very minimal clinical changes were also seen in the control group and melanin index was decreased from 62.65 ± 2.23 to 61.25 ± 2.34 (p = 0.004). Clinically significant differences were observed in the rate of changes between both groups. These findings indicate that topical isoniazid has significant depigmenting effects compared to the placebo (p = 0.001). The erythema index remained unchanged in both groups. In the treatment group, the mMASI score was 5.63 ± 3.28 at baseline and 2.13 ± 1.71 at the last follow-up, significantly reduced compared to the control group (p = 0.002). The MELASQOL score indicated a significant improvement in the quality of life in the treatment group. This clinical trial shows for the first time that topical isoniazid is effective in treating melasma. Further clinical trials are necessary to confirm the efficacy and tolerability of topical isoniazid in comparison with other skin-depigmenting compounds.

Different therapeutic approaches in melasma: advances and limitations.

Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.

Dermoscopic features of Melasma

Melasma, is a chronic acquired disorder of hypermelanosis of skin which is exposed to ultraviolet radiation. The clinical presentation is most often in the form of hyperpigmented patches over the face in three common patterns: Centrofacial, malar and mandibular. It is commonly seen in pigmented skin phenotypes (Fitzpatrick skin types III-V). The disease has an impact on the quality of life of patients. Dermoscopy is an in vivo noninvasive technique used to examine pigmented and amelanotic skin lesions. The technique is performed using a hand-held self-illuminating device called dermatoscope that visualizes features present under the skin surface. : To study dermoscopic (dermatoscopic) features of melasma and to distinguish between epidermal and dermal melasma based on dermoscopic features.: This study was conducted in an OPD in a clinic on 40 patients of melasma. Dermoscopy was done and their dermatoscopic features were recorded, melasma was classified as epidermal or dermal depending on dermatoscopic features. : Dermatoscopic features of melasma seen were – Accentuation of pseudoreticular pigment network, light to dark brown in colour sparing of the periappendageal region (follicular and sweat gland openings), brown granules, blue- gray perifollicular accentuation honeycomb like reticular pattern and arcuate pigmented lines. 18 patients (45%) showed epidermal type 9 patients (22.5%) revealed dermal type of melasma, 13 patients showed mixed features (epidermal and dermal). Melasma with steroid abuse showed marked erythema and telangiectasia. Dermatoscope is a valuable aid to diagnose, classify and to monitor treatment of melasma.

Applying Artificial Intelligence to Support the Detection and Treatment of Melasma

This study, we propose a solution to apply artificial intelligence to assist in detecting whether a person may have melasma or not through data sets related to information about a person's daily activities, then If we detect a person with a high likelihood of having melasma, we will apply machine learning to diagnose the type of melasma through a photo taken of that person. Through a machine learning model of predicting and diagnosing a person's melasma, we also suggest relevant prevention and treatment options based on the disease's prevention and treatment regimen. Our method build predict Melasma model based on Catboost machine learning algorithm on users' data combined with medical practice data commu-nity by dermatologists to predict the disease and make some necessary recommendations in the patient screening. Based on our dataset, we have statistically described the data characteristics as well as the correlated data parameters that may cause Melasma. The method using for diagnosing melasma disease based on machine learning algorithms with input data being facial images. we built a machine learning model for diagnosing melasma to detect melasma objects to support dermatologists in predicting the risk of melasma in a person after entering his/her facial image. Our dataset of facial images combined with the expertise of melasma experts to classify different types of melasma. We used YOLO V8 with machine learning algorithms to detect melasma objects to build a diagnostic model for whether a patient has melasma and with which type of melasma such as central melasma, butterfly-shaped melasma, or mandibular melasma.

Tranexamic Acid in the Treatment of Melasma: A Comprehensive Review of Topical, Intradermal, and Oral Administration

A malfunction in human melanogenesis called melasma causes the epidermis to become hyperpigmented in certain regions of the body gradually. It significantly affects physical appearance, results in psychological and physiological distress, and diminishes those impacted individuals' quality of living. In order to restrict blood loss, tranexamic acid (TA), a plasmin inhibitor, is used for stopping unusual fibrinolysis. It works by permanently inhibiting lysine binding sites on plasminogen molecules, which prohibits plasminogen activator (PA) from converting plasminogen to plasmin. It seems sense that tranexamic acid might have an impact on keratinocyte association and function because plasminogen is additionally found in human epidermis basal cells and owing to the fact that PA has been shown to be produced by cultivated human keratinocytes. A comprehensive review of the literature demonstrates that although TA is administered by topical, oral, and intradermal injection as well as utilized as an adjuvant therapy Added to the laser therapy to treat melasma, its effectiveness has not been sufficiently proved. To fully understand the function of TA in the management of melasma, additional investigation is required.

Melasma and reflectance confocal microscopy: from baseline to treatment monitoring.

Melasma is a frequent condition worldwide, and it represents one of the most challenging disorders to treat in cosmetic dermatology. One of the critical factors for treatment prognosis is the assessment of the depth and distribution of pigment within the hyperpigmented area. Nowadays, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to estimate pigment distribution and depth within different skin layers. This article aims to provide a systematic review of RCM applications in melasma, providing terminology and investigating characteristics of melasma at baseline and after medical and laser treatment. Our results support the recognition of two main types of melasma, epidermal and mixed type, thanks to the role of RCM in highlighting the precise pigment depth location in the skin non-invasively. RCM treatment monitoring enables the objectification of pigment variations after treatment and the identification of prognostic factors for different treatment modalities. After the era of the application of RCM as a technique applied strictly to skin cancers, additional cosmetic applications are emerging, such as the application of melasma treatment monitoring.