The history of melasma: Its roots and evolution

Abstract

Melanosis or “black degeneration” was the first term used to describe a diseased state involving darkening of visceral structures. In 1910, melanosis localized to the skin was described and years subsequent to that the term chloasma was coined to describe dark facial pigmentation. Melasma and chloasma were used interchangeably for many years until melasma became the more widely used term to describe dark facial pigmentation in a butterfly distribution. For decades, there have been various theories regarding the etiology of melasma. In the 1930s, it was theorized to have been caused by perfume application to the upper cutaneous lip and was associated with vitamin C deficiency. It was thought to only occur in women until cases arose of in men around 1988. It was also thought to occur exclusively in white skin until studies in the early 1960s found the incidence of chloasma to be as high as 34% among Puerto Rican women taking contraceptives. It was not until 1963 that a study found an association between melasma and oral contraceptive use, tying the cause of the pigmentation to underlying hormonal exposure. To date, there has been a significant increase in the understanding of the pathogenesis of melasma as well as treatment options to keep it in remission, though no cure exists at this time. The purpose of this study is to provide a historical overview of the evolution of melasma as a clinical condition as well as an understanding of its pathogenesis and treatment options.