Melasma

Abstract

Melasma (a term derived from the Greek word melas, meaning black) is a common acquired hypermelanosis that occurs on sun-exposed areas, mostly on the face and occasionally on the neck and forearms. The exposure to ultraviolet radiation and genetic and hormonal factors are the most important causative factors of melasma. The principles for melasma therapy include the inhibition of the activity of melanocytes (protection from sunlight and avoidance of precipitating factors), the inhibition of the synthesis of melanin (bleaching agents), the removal of melanin (chemical peeling) and the disruption of melanin granules (lasers). At present there is no standard therapy for melasma. Topical hydroquinone, alone or in a triple-combination formula, is the first line of treatment. It is the most widely studied agent with reported efficacy for patients with melasma. Fractional laser is the only laser treatment approved by the FDA for melasma and it has shown promising results. Melasma treatment should be tailored to the clinical subtype and disease severity to optimize therapy.