Near-visible light and UV photoprotection in the treatment of melasma: a double-blind randomized trial

Summary Background Melasma is an acquired hyperpigmentation on sun‐exposed areas. Multiple approaches are used to treat it, but all include broad ultraviolet (UV)‐spectrum sunscreens. Visible light (VL) can induce pigmentary changes similar to those caused by UV radiation on darker‐skinned patients. Objective To assess the efficacy of sunscreen with broad‐spectrum UV protection that contains iron oxide as a VL‐absorbing pigment (UV‐VL) compared with a regular UV‐only broad‐spectrum sunscreen for melasma patients exposed to intense solar conditions. Methods Sixty‐eight patients with melasma were randomized in two groups to receive either UV‐VL sunscreen or UV‐only sunscreen, both with sun protection factor ≥ 50, over 8 weeks. All patients received 4% hydroquinone as a depigmenting treatment. At onset and at conclusion of the study, they were assessed by the Melasma Activity and Severity Index (MASI; a subjective scale), colorimetry (L*) and histological analysis of melanin. Results Sixty‐one patients concluded the study. At 8 weeks, the UV‐VL group showed 15%, 28% and 4% greater improvements than the UV‐only group in MASI scores, colorimetric values and melanin assessments, respectively. Conclusions UV‐VL sunscreen enhances the depigmenting efficacy of hydroquinone compared with UV‐only sunscreen in treatment of melasma. These findings suggest a role for VL in melasma pathogenesis.