Abstract
Melasma is one of the most common aesthetic problems in Asians and is one of the most difficult conditions to be treated. In the past result after laser treatment was usually believe to be unpredictable. This believes was based on anecdotal reports with variable laser parameters. In order to get better and long lasting result, we need to understand biology of melanin synthesis, pathogenesis of melasma, laser / light tissue reaction, sun screen and effect of whitening agents.
Highlights
Melasma is one of the most common aesthetic problems in Asians and is one of the most difficult conditions to be treated
Melanins are synthesized in epidermal melanocytes and transfer to epidermal keratinocytes
The binding of keratinocytes and melanocytes is through binding of Stem Cell Factor (SCF) on keratinocytes and C-kit protein on melanocytes
Summary
Most of melasma patients are photo skin type III to V. Mature melanin present in all these locations; keratinocytes, epidermal melanocytes and melanophages. Histologic study in melasma in Asians has demonstrated that, majority (more than two third) of melasma is a combination of epidermal melanocytes hyperactivity, increase in melanocytes with dermal melanophages There is no such condition that has been called dermal melasma. Many new combination drugs with medications that interfere with melanin biosynthesis pathway e.g. tyrosinase inhibitors (e.g. alphaArbutin) + exfoliating agents (e.g. glycolic acid) + transfer of melanins blocking (e.g. niacinamide) has recently been available. This product often resulted in mild to moderate whitening effect but is safe for long term use
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