Melasma (derived from Greek word- melas) is an acquired pigmentary condition of sun-exposed skin, often manifest as brown, grey or black patches on the face. Cheeks, forehead, upper lip, nose and chin, are involved usually in a symmetrical manner. Often, it may be limited to the cheeks and nose area. Other sun-exposed areas such as the neck and the forearms are uncommonly affected. This mainly poses cosmetic problems and generally these lesions are not itchy. Melasma usually occurs more commonly in women than men, it is not hereditary but peoples with a positive family history are more susceptible. Another term for this is chloasma which is often used to describe melasma occurring during pregnancy.
Common contributory factors for Melasma are sun exposure, pregnancy, drugs (such as phenytoin, oral contraceptive pills or hormone replacement therapy), family history and hypothyroidism. Exact cause of Melasma is not yet clear. It is likely to occur when the color making cells (melanocytes) produce excessive pigment in the skin of the affected areas.
All dark patches on the face are not melasma. Melasma is usually diagnosed by the clinical appearance of skin lesions and a dermatologist can confirm the diagnosis by simple examination with a Wood’s lamp or dermatoscopy and will start appropriate treatment.
First and foremost limited sun exposure and sun protection are recommenced along with which a combination of topical, oral, and procedural treatment modalities is helpful. Year-round life-long sun protection is recommended and the use of broad-spectrum very high protection factor (SPF 50+) sunscreen applied to the whole face every day. It should be reapplied every 2 to 3 hourly, if outdoors during the summer months. Wear a broad-brimmed hat. Discontinue hormonal contraception in females. Makeup or skin creams can be used to camouflage the pigmented lesions.
Skin lightening creams with quinol (2–5%) based formulations applied accurately to pigmented areas at night for 3–4 months is useful. Self- medication with steroid containing creams should be strictly avoided. Various new topical agents under investigation include zinc sulfate, resveratrol, 4-hydroxy-anisole, 2,5-dimethyl-4-hydroxy-3(2H)-furanone and/or N-acetyl glucosamine.
Oral medications including tranexamic acid and glutathione for melasma are under investigation,
Chemical peels with glycolic acid, lactic acid, TCA, laser therapy with Q-switched Nd YAG, carbon dioxide or erbium: YAG resurfacing lasers and microdermabrasion are used in resistant cases.
Melasma cannot be fully cured, however multiple treatment options available can improve the appearance. Melasma tends to recur and recurrence rates are higher if sun protective measures are not adequately followed.