melanogenesis and the melanocyte cell cycle. 5,6 Tryptase activates MMP1 and MMP-9, which degrade type I and IV collagens leading to extracellular matrix degradation (solar elastosis) and basement membrane damage. 7 Mast cells also induce vascular proliferation by secreting VEGF, FGF-2 and TGF-b. 8 These elements support the role of mast cells in sustained melanogenesis in melasma. 2 Ketotifen decreases the release of bioactive mediators, such as histamine, leukotrienes and proteases. It has been suggested as a treatment for photoaging after being found to prevent mast cell deposition, degranulation, skin thickening and wrinkles in UVirradiated hairless mice. 9 Famotidine is a H2-receptor antagonist that suppresses histamine-mediated melanogenesis and dendricity in cultured human melanocytes, whereas H1 and H3 antagonists have no inhibitory effect. 10 This study provides proof-of-concept evidence for targeting mast cells as a possible treatment for melasma, which should be explored in combination with other strategies to maximize their benefits and prevent the relapse of melasma, after bleaching.In conclusion, oral ketotifen associated with famotidine was well tolerated and promoted a slight improvement of facial melasma.