The future of melasma therapy

Abstract

AbstractMelasma is a chronic dermatologic condition defined by hyperpigmented macules and patches that appear in areas of sun exposure. Common areas of involvement include the forehead, cheeks, nose, and upper lip. Though melasma occurs in all genders and skin types, it is more commonly seen in females of Latin and African ancestry. Risk factors for the development of melasma include ultraviolet and visible light, high levels of estrogen, and family history. Histopathologic findings often include vacuolization at the basement membrane, increased melanin in the basal and suprabasilar layers of the epidermis with increased melanosomes and prominent dendrites; however, there is no increase in the total number of melanocytes. Newer findings reported also include an increase in vasculature and mast cells in lesional skin. Treatment of melasma includes an array of topical and oral medication in addition to various procedures. Medication treatment includes topical skin lightening agents that contain hydroquinone, azelaic acid, kojic acid, ascorbic acid, and newly released cysteamine. Tranexamic acid (TXA), both compounded in a topical form and given orally, has also been utilized with success. There is also a multitude of procedural treatments indicated for melasma, including micro‐needling and intradermal injections. Treatments, both topical and procedural, are often combined together for maximum benefit. Regardless of which option(s) you choose, it is of the utmost importance to adhere to strict sun protection to minimize the risk of continued recurrence, as UV and visible light exposure are often the culprits of melasma relapse.