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Sixty-one patients completed the 8-week investigation as planned in the protocol (Fig.?2). The UV-Vis and UV-only groups did not significantly differ in demographics, clinical features or melasma history (Table?1). The final average MASI scores were considerably reduced compared with initial scores for the UV-Vis and UV-only group (P?crotamiton for both groups. However, the final ��L* improvement in the UV-Vis group was significantly superior to the attained by the UV-only group (2.3?��?1 vs. 3.5?��?2.2, P?=?0.01; Table?2). The erythema axis values (a*) did not significantly change from the onset to the end of trial, nor did final values significantly differ for either group (Table?2). Good or excellent responses in PGA scores were significantly better in the UV-Vis group, at 75%, compared with 47% for the UV-only group (X2; P?=?0.03; Fig.?4). No side effects were reported during the trial for either sunscreen, although two patients in the UV-Vis Wnt inhibition group and three in the UV-only group presented mild and transient facial irritation from HQ within the first 4 weeks of use. Fontana�CMasson staining showed epidermal melanin to decrease significantly U0126 datasheet in the UV-Vis and UV-only group. However, relative improvement in the UV-Vis group was 32%, compared with 19% for the UV-only group (Fig.?5; Table?2). The two groups did not significantly differ in initial mean number of mononuclear cells/mm2. However, we found numbers of mast cells in affected skin were significantly reduced in the UV-Vis group compared with the UV-only group. Epidermal thickness remained unchanged after both interventions. These data are shown in Table?2. Melasma is common among Latin American women. Its treatment is challenging due to frequent relapses and treatment resistance. Although VL sunscreens have been suggested to treat or prevent melasma [7, 15], no randomized controlled trials have quantified its benefits. In tropical areas, affected patients are heavily exposed to solar radiation, of which the visible component apparently surpasses the minimal pigmentation response [7, 9]. Therefore, VL exposure could exacerbate poor clinical outcomes in these settings. At the end of our trial, both sunscreens had reduced hyperpigmentation; but the UV-VL group achieved greater improvements in MASI scores, GPA, colorimetric measurements and melanin expression. Whereas use of UV sunscreen alone reportedly gave a 60% reduction in MASI score [16], 4% HQ and UV sunscreen combined reduced MASI score by 75% on average [13, 17].