Efficacy and safety of cysteamine in the treatment of melasma: a systematic review and meta-analysis of randomized controlled trials

Melasma is a persistent and recurrent pigmentation disorder that significantly impacts patients’ quality of life and presents challenges in management with conventional treatments. Cysteamine has gained attention as a promising depigmenting agent, particularly for epidermal melasma, due to recent enhancements in its formulation. This review critically examines the effectiveness of a 5% cysteamine cream in treating melasma. A comprehensive search was conducted using multiple databases, including Google Scholar, PubMed, Web of Science, Scopus, and Mendeley, up to July 14, 2023, adhering to PRISMA guidelines. Statistical analysis was performed using Review Manager 5.4, and the risk of bias was evaluated using the Cochrane Risk of Bias Tool for Randomized Trials. The meta-analysis incorporated data from six studies, encompassing 154 melasma patients treated with 5% cysteamine cream. The findings reveal that 5% cysteamine significantly improves melasma (MD 544 [95% CI 309–780], P