Melasma is a common skin pigmentation disorder that primarily manifests on the face, with hyperpigmented patches appearing in areas exposed to the sun. It appears as symmetrical brown or gray-brown spots, most commonly on the cheeks, forehead, upper lip, nose, and chin. This condition is more frequent in women, especially those with darker skin (Fitzpatrick III–V type).
Causes and Mechanisms of Development
The causes of melasma are diverse. One of the primary factors is sun exposure (ultraviolet and visible rays), which stimulates melanocyte activity, increasing melanin production. Hormonal influences also play an important role, as melasma often occurs during pregnancy (known as chloasma or the "mask of pregnancy"), or with the use of contraceptives or hormonal treatments.
Notable factors include genetic predisposition, thyroid disorders, certain medications, or cosmetic products that make the skin more sensitive to light. In melasma, from a dermatological perspective, there is an increase in melanin in the epidermis, dermis, or both, depending on the type of melasma.
Clinical Picture
Three main forms are differentiated:
•
Epidermal Melasma
– light brown, well-defined edges, which intensifies under Wood's lamp examination.
•
Dermal Melasma
– grayish or bluish color, poorly defined edges, which does not intensify under Wood's lamp.
•
Mixed Form
– contains features of both types.
Diagnosis
The diagnosis is primarily based on the clinical presentation. Wood's lamp examination plays a supporting role, as it helps determine whether the pigment is located in the epidermis or dermis. If necessary, dermatoscopy is performed.
Treatment
The treatment of melasma requires a comprehensive and individualized approach, as it has a chronic and recurrent course.
1. Sun Protection
– the most important step. Broad-spectrum sunscreens with SPF 50+ should be used daily to protect against UVA/UVB rays.
2. Topical Treatment
– skin lightening agents such as hydroquinone, azelaic acid, and niacinamide are used.
3. Aesthetic Interventions
– chemical peels and laser therapy (e.g., Q-switched Nd:YAG) can improve the appearance of the skin, but they must be done with caution, especially in individuals with darker skin, as they may cause post-inflammatory hyperpigmentation.
Conclusion
Melasma is a benign but long-lasting condition. Although it may not always fully resolve, consistent treatment and the use of sun protection can lead to noticeable improvement. Patients should be informed that recurrences are possible, and it is crucial to maintain sun protection, avoid irritating agents, and perform gentle care.