Emerging Oral Therapies for Melasma

Conclusions

• The presentation concludes that oral therapies are increasingly important adjuncts in melasma management, but they should complement, not replace, strict photoprotection and standard topical care.
• Oral polypodium leucotomos is presented as a useful antioxidant adjunct that may improve photoprotection and possibly vascular components of melasma, with newer formulations adding niacinamide as a promising development.
• Topical and possibly systemic methimazole appear to be emerging off-label options because peroxidase inhibition may improve pigmentation, but the evidence is still early and limited.
• Oral glutathione is viewed skeptically because of poor bioavailability, lack of robust clinical evidence, and safety concerns, especially for intravenous use.
• Tranexamic acid is the strongest and most widely adopted oral option discussed, with rapid clinical benefit in many patients, but it requires careful screening for thrombotic risk and thoughtful documentation.
• Emerging oral agents such as metformin, pycnogenol, astaxanthin, zinc, and antihistamines may have promise, but most still have limited evidence compared with tranexamic acid.
• Antihistamines may help by reducing mast-cell mediated inflammation and downstream melanogenic signaling, but current support is still mostly mechanistic and preliminary.
• Overall, the speaker's conclusion is that oral melasma therapy is a rapidly expanding field, with tranexamic acid leading the way and several other agents needing stronger clinical trials before routine first-line use.