Objectives: Melasma is common in dark skin individuals and woods light is often not useful in assessing depth of melasma. Approximately 80% of the Indian population present skin color heterogeneity on the face, irrespective of age and gender.
Introduction: Melasma is a common acquired pigmentary skin disorder characterized by a symmetrical macular pigmentation of sun-exposed areas like the face
The three major patterns of pigmentation in melasma are centrofacial (cheeks, forehead, upper lip, and nose), malar (cheeks and nose), and mandibular (mandibular area of cheeks)
Materials / method: Wood’s lamp examination is done to identify the location of pigment but is limited to epidermal melasma and cannot be used reliably in Fitzpatrick skin types V and VI as dark skin melanin pigmentation obscures the detection of dermal melanin.
Wood's lamp examination (340 to 400nm) highlights the difference in pigmentation of the affected skin. Broad spectrum sun screen with SPF of atleast 30, which covers UVA, UVB and visible light. It should be applied liberally (tea spoon rule) every 2-3 hours. Triple combination containing hydroquinone tretinoin and flucinolone acetonide is still first line
Results: 40 women from India treated with serial peels + modified Kligman’s formula (MKF) vs. MKF alone for 5 months. Peel group showed better response in an Indian study.
Tranexamic acid, an anti-fibrinolytic agent, through inhibition of plasminogen activator pathway in skin, is proposed to act by preventing melanocytes activation due to ultraviolet (UV) light, hormones, and injured keratinocyte. Lasers can be used as an adjuvant therapy in resistant cases, provided the selection of patient and counselling has been done properly.
Conclusion: triple combination with chemical peels is preferred first line therapy in Indian patients.
Lasers need to be used carefully in dark skinned patients.
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