Melasma is an acquired skin disease characterized by symmetrical hyperpigmentation of photo-exposed areas of the face, especially the central part and, more rarely, the neck. It is mainly observed in women of reproductive age. Although all races are affected, melasma is more common in dark skin types. The predominant age of onset of the disease is the second to third decade of life.
Melasma is an acquired skin disease characterized by symmetrical hyperpigmentation of photo-exposed areas of the face, especially the central part and, more rarely, the neck. It is mainly observed in women of reproductive age. Although all races are affected, melasma is more common in dark skin types. The predominant age of onset of the disease is the second to third decade of life.
Various clinical distribution patterns have been described.
- The centrofacial is the most common and concerns the area of the forehead, nose, and upper lip.
- The buccal: concerns only the area of the nose and the cheeks.
- The mandibular form: which is located in the area of the lower jaw.
- A more recently described form is extra facial melasma, where anatomical areas outside the face are affected, including the neck, arms, and sternum.
Solar radiation (UV) exposure is considered the most important causative factor. However, hormonal factors also appear to be involved. This association is strengthened by the predominance of women among melasma patients and by the reported onset or worsening of the disease during pregnancy or after systematic intake of birth control pills or other hormonal treatments.
Treating melasma includes: topical preparations, systemic treatments, and a combination of these. The duration and effectiveness of the treatment depend on the pathogenesis, the clinical form, and the patient's phototype.
- Topical treatments: Hydroquinone, tretinoin, and 4n-butyl resorcinol act by a specialized mechanism, inhibiting melanogenesis in the skin. Topical treatment with bleaching agents improves discoloration, but incorrect use can create skin irritation and worsen hyperpigmentation. For this reason, frequent dermatological monitoring is deemed necessary.
- Chemical peels: The most effective peels for treating melasma are those of the hydroxy acid category. With salicylic, glycolic, citric, Kochi, and trichloroacetic acid as the main ingredients, the dermatologist chooses one of the above ingredients depending on the patient's phototype. Chemical peeling removes excess melanin from the skin. However, great care is required in its application as there is a risk of causing irritation and post-inflammatory hyperpigmentation.
- Systemic treatments: tranexamic acid has been used recently with excellent results.
