Melasma is a pigmentary disorder of unclear etiology with numerous treatment options and high recurrence rates. Laser and light therapies may be utilized cautiously as second- or third-line options for recalcitrant melasma, but low-energy settings are preferred due to the risk of postin- flammatory hyperpigmentation and melasma stimulation. Commonly used lasers include the low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, nonablative fractionated lasers, and intense pulsed light. Strict sun protection, concomitant use of bleaching agents, and maintenance treatments are necessary. A variety of other treatments that may also help to improve results are now being more widely adopted, including oral tranexamic acid, pulsed dye laser, antioxidants, and laserassisted drug delivery.
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