Clinical recommendationEvidence ratingReferences
High-potency, broad-spectrum (ultraviolet A and B) sunscreens may prevent melasma.C1, 2
Severe epidermal melasma may be treated postpartum with combinations of topical tretinoin (Retin-A), hydroquinone (Eldoquin Forte), and corticosteroids.B9, 10
Ursodeoxycholic acid (ursodiol [Actigall]) effectively reduces pruritus and serum bile acid levels in patients with severe intrahepatic cholestasis of pregnancy.B18, 27
Patients with intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and pemphigoid gestationis should receive antepartum surveillance.C18, 22