Objectives: - Up date of new insights in melasma pathogeny,
- Strategy of treatment based on holistic and integrative approach,
- Tips and tricks for laser treatment.
Introduction: Melasma is a commonly acquired hypermelanosis characterized by symmetric, reticulated, hyperpigmentations of sun-exposed areas of the skin, particularly the face. Melasma has a higher prevalence in women and patients of darker skin tones, although it can occur in all skin types.
The dyspigmentation caused by melasma often has a negative psychosocial impact on those affected with the condition as demonstrated by patient-reported anhedonia, decreased self-esteem, dissatisfactory mood, and impairment in social and occupational functioning
Materials / method: The pathogenesis of melasma is still unclear, however various factors have been implicated and well supported such as ultraviolet radiation exposure, genetic predisposition, and hormonal influences.
Features of the involved skin include solar elastosis and increased mast cells, dermal blood vessels, altered basal membrane, abnormal barrier function and expression of vascular endothelial growth factor.
The latest evidence on the pathophysiology of melasma suggest that melasma might be a photoaging skin disorder affecting genetically predisposed individuals.
Results: Due to the incomplete understanding of its pathogenesis and the high recurrence rate, melasma remains a difficult disorder to manage resulting in physician frustration and patient dissatisfaction.
Several topical, oral, and procedural treatment options are available with varying mechanisms of action addressing the multifactorial nature of the disorder. The treatment of melasma remains highly challenging with inconsistent results and almost constant relapses.
Conclusion: A multimodality approach addressing the multifactorial nature of the disorder is optimal.
Daily photoprotection (with broad spectrum sunscreens that combine UVA and UVB filters with visible light blockers), topical therapies, chemical peelings, systemic products and procedures (chemical peels, microneedling, and lasers) could be used in various combinations in order to treat melasma.
Several new therapies are emerging as promising agents to treat melasma, but further clinical studies are warranted to investigate their efficacy.
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