Melasma is one of the most common pigmentary disorders presenting to the dermatology clinics. The exact cause of melasma is unknown. Plenty of oral as well as topical medications are available for the management of melasma.
Causes of melasma:
Melasma manifests as symmetric hyper pigmented macules on the face. It is common in people with Fitzpatrick skin types 4 to 6. Some of the causative factors are:
Patients with melasma have increased levels of luteinizing hormones and low levels of serum estradiol.
Drugs like phenytoin may lead to development of melasma.
Pregnancy : Is a known factor in the development of melasma.
Sun Exposure : Also leads to the development of melasma.
Pigmentation and darkening of the skin is noted on the cheeks, nose as well as the forehead. Sometimes a generalised diffuse pigmentation is noted. There are 3 main patterns of distribution: Centro facial, malar and mandibular.
Hydroquinone and triple combinations are considered as gold standards in the management of melasma.
However they should be prescribed for a shorter period. Milder depigmenting agents like kojic acid, azelaic acid, glycolic acid can be given for a longer duration to avoid side effects of long term use of hydroquinone.
Chemical peels like glycolic acid peels or retinol peels also provide good results.
Recently tranexemic acid has been used in the management of melasma with good results. Both oral as well as topical formulations are used.
Melasma is a chronic condition with a high tendency to relapse. However with proper medications as well as sun protection, excellent results are obtained.