Efficacy and Safety of Cysteamine in Melasma in Patients of Skin of Colour: A Brief Report.

Background: Melasma is a common disorder of pigmentation. Traditional treatments often come with limitations, prompting the need for alternative newer therapies. Cysteamine cream, a new topical depigmenting drug, has shown potential in treating melasma while maintaining a good safety profile.

Aim: This case series aims to evaluate the efficacy and safety of cysteamine cream in treating melasma in patients of skin of colour (Fitzpatrick's skin types III, IV, and V).

Patients and methods: Ten Indian women with Fitzpatrick skin types III-V with epidermal melasma diagnosed clinically and by Wood's lamp examination, with history of no other medications other than sunscreen use in the last 4 weeks, applied cysteamine cream (5% cysteamine hydrochloride) once daily for 15 minutes, followed by rinsing with water, over 6 weeks. Broad-spectrum sunscreen with SPF 30+ was used during the day. The primary outcomes were the modified Melasma Area and Severity Index (mMASI) score and patients' satisfaction score.

Results: All patients showed a significant reduction in mMASI scores, with an average improvement of 29.72%. High patient satisfaction (44.6%) was reported, and adverse effects reported in minority (20%) were minimal, including transient mild stinging and lightening of surrounding skin.

Limitations: Small sample size, lack of a control group, and no long-term follow-up.

Conclusion: Cysteamine cream is an effective and safe treatment for melasma in women of colour. This case series supports its use as a first-line therapy for melasma, offering a promising option for patients who may experience adverse effects from traditional treatments.