Melasma is an acquired pigmentary condition consisting of symmetric patches of hyperpigmentation. It occurs on sun exposed areas and most commonly on the face. Studies have shown that melasma typically affects women of reproductive age with average age ranging being between 20 and 30 years. It can occur in all skin types but it is usually seen in darker skin types.
Its predominant clinical patterns are:
– Centrofacial pattern, which affects the forehead, nose and upper lip. It is the most common one.
– Malar pattern which affects the malar cheeks on the face.
– Mandibular melasma is present on the jawline and chin.
– A newer pattern has been described, the extra-facial melasma which can occur on non-facial body parts, including the neck, sternum and forearms.
Although melasma is mainly linked to ultraviolet exposure to ultraviolet (UV) exposure, hormonal influences are implicated in its development. The latter is further supported by the increased prevalence with pregnancy, oral contraceptive use and other hormonal therapies.
Treatments for melasma include topical, systemic and combination treatments which target different aspects of its pathogenesis. Duration and efficacy to treatment vary due to the variability in clinical presentation, pathogenesis and response to treatment amongst different skin phototypes.
– Topical treatments, including photoprotection, hydroquinone, retinoid, 4-n-butylresorcinol have shown significant improvement in pigmentation in melasma. However, frequent dermatology surveillance is needed as in same cases they can cause an irritant dermatitis or even worsen the hyperpigmentation.
–Chemical peelings are frequently used in combination with other topical products due to their ability to achieve the removal of unwanted melanin. Amongst the various peels, glycolic acid, salicylic acid, kojic acid and trichloroacetic acid have been successfully used to treat melasma. Dermatologist will chose the appropriate peeling according to patient’s phototype. Caution is needed as there is always the risk of topical irritation and post-inflammatory hyperpigmentation to occur.
–Systemic treatment with tranexamic acid has been recently used with promising results.