Melasma and Post-Procedure Hyperpigmentation: From Prevention to Precision Management

Resumen

Melasma and post-procedure hyperpigmentation (PPH) are prevalent pigmentary diseases with a complex pathogenesis, recurrent and intermittent response to therapy due to their multifactorial causes. The aim of the review was to evaluate the available data on the prevention and precise treatment of melasma and PPH with emphasis on the peculiarities of treatment and innovative technologies. Systematic literature review was carried out over PubMed/MEDLINE, Scopus, Embase, Web of science, Cochrane Library and Google Scholar. The number of studies counted up to 52 studies that met some predefined eligibility criteria that were published in the years 2015-2026 with 18 randomized controlled studies, 15 observational studies, 12 systematic reviews/meta-analyses and 7 clinical guidelines. The results showed that the major risk factors that lead to the development and maintenance of the disease were exposure to ultraviolet light, hormonal effects, genetic inclination, and dark skin phototypes. The use of preventive measures (priming of skins and strict photoprotection) and adequate procedure selection helped to reduce pigmentation-related complications at all times. The clinical efficacy of hydroquinone, tranexamic acid, microneedling, chemical peels and laser-based interventions (combinations) was highest and very high, and individualized treatment programs showed the lowest recurrence rates and patient satisfaction. Another addition to the accuracy of the management was the new technologies, such as the artificial intelligence-aided diagnosis, the biomarker-guided therapy, the drug delivery via nanotechnology. Overall, there is evidence supporting the combination of preventive and individual treatment to optimize the clinical outcome, minimize the recurrence and improve long term management of melasma and post-procedure hyperpigmentation.