From consensus to continuity: Redefining long‐term melasma management

Melasma is a chronic, multifactorial pigmentary disorder that predominantly affects women with darker skin phototypes and remains a persistent challenge in dermatologic practice. From daily clinical experience, its management is often complicated not only by the biological heterogeneity of the disease, but also by high relapse rates and a substantial psychosocial burden. These factors frequently compromise long-term adherence and highlight the need for structured, evidence-informed and globally applicable management strategies.1 In this context, the Delphi consensus on melasma management by Sarkar et al. represents a timely and clinically relevant contribution.2 The structured Delphi methodology allows expert opinion to be translated into pragmatic recommendations, capturing agreement across different regions, skin phototypes and healthcare realities, while acknowledging inevitable variations in access to treatments. One of the most important messages emerging from this consensus is the reaffirmation of melasma as a chronic and relapsing condition rather than a transient cosmetic concern. This distinction is not merely semantic; it reframes therapeutic success away from short-term clearance and towards sustained disease control. Consequently, effective management must rely on three inseparable pillars: strict photoprotection, rational combination therapy and proactive maintenance strategies. When considered alongside the recently published Global consensus on the management of melanin hyperpigmentation disorders, the coherence between both documents becomes evident.3, 4 Together, they support a pathophysiology-driven paradigm in which melasma management extends beyond melanocyte-targeted therapies to include the broader cutaneous microenvironment, incorporating inflammatory, vascular and dermal components, while reinforcing the central role of long-term photoprotection. Photoprotection is therefore appropriately positioned as the cornerstone of management. In particular, the emphasis on protection against both ultraviolet radiation and visible light—through the use of tinted sunscreens containing iron oxides—addresses a frequent gap observed in routine practice and aligns with current understanding of melasma pathogenesis. Regarding active treatment, the consensus confirms hydroquinone-based triple combination therapy as the gold standard for first-line management, while clearly discouraging prolonged or unsupervised use. Of equal importance is the attention given to maintenance therapy, advocating rotation towards non-hydroquinone agents to reduce the risk of rebound hyperpigmentation and cumulative adverse effects—an aspect that remains underestimated in everyday practice. The role of oral tranexamic acid in selected patients with moderate-to-severe melasma is also addressed with appropriate caution, emphasizing patient selection and safety considerations. Procedural interventions, including chemical peels, microneedling and lasers, are correctly positioned as adjunctive options reserved for carefully selected refractory cases. Importantly, several recommendations are supported by moderate levels of evidence, underscoring persistent gaps in knowledge. By explicitly acknowledging these limitations, the Delphi consensus not only guides current practice but also helps define priorities for future research, particularly in maintenance strategies and relapse prevention. In summary, the Delphi consensus by Sarkar et al. offers a pragmatic and globally relevant framework for melasma management. Its greatest value lies in reinforcing continuity of care, individualized decision-making and long-term disease control—principles that are essential for improving real-world outcomes in patients with melasma. The authors declare no conflicts of interest related to this commentary. Data sharing is not applicable to this article as no new data were created or analysed in this study.