Evolving Approaches to Treating Melasma Highlighted at AAD

Use of imaging and aggressive treatment are critical in the medical management of melasma in 2025, Mukta Bhardwaj Sachdev,MD, IFAAD, said at the 2025 American Academy of Dermatology (AAD) Annuel Meeting in Orlando, Florida.

“You need to use imaging systems, monitor your patients, [use] topicals and oral systemic agents together, peels, lasers, needling,” Dr. Sachdev said. “We see that dermatologists are more aggressive with their approach for melasma. Procedures have almost become first-line. And now, the new thinking is that we want you to think about melasma as a photoaging disorder, have an etiological approach, and [know that] genetics is the future.”

That etiological approach, Dr. Sachdev said, is based on seven etiologies: sun exposure, barrier function, pollution, hormones, microbiome genetics, and a vascular etiology.

Dr. Sachdev highlighted the importance of understanding that, in addition to photo damage, areas of melasma histamine are produced by mast cells inducing melanogenesis. As a result, she said, the H1 antihistamine loratadine has a strong antigenic effect.

Another new development, she said, is the revelation that the incidence of melasma is very high in geographic areas with heavy pollution.

“So, there's now a new thought process that the use of cleansers and anti-pollution measures can assist in reducing pigmentation,” she said.

With so many causal factors and so many treatment approaches available, Dr. Sachdev concluded that physicians need to stay up to date and be aggressive in treatment of melasma.

“It remains a chronic, therapeutically challenging, and universally relapsing condition,” Dr. Sachdev said. “Treat it like a thyroid dysfunction. Tell your patients it's chronic. It needs constant management. It is a psychologically devastating disorder. So, you need to have a multimodality and a dynamic, flexible approach. So, physician awareness of the newer treatments is key to expand your repertoire of therapies.”