The stepwise approach to the treatment of melasma

Melasma is a symmetric progressive hyperpigmentation of facial skin that occurs in all races but has a predilection for darker skin phenotypes. Melasma has been associated with hormonal imbalances, sun damage, and genetic predisposition. Clinically, melasma can be divided into centrofacial, malar, and mandibular according to the pigment distribution on the skin. On Wood light examination, the pigment can be found within the epidermis, where it will enhance, or within the dermis, where it will not enhance. Melasma can be classified as mild, moderate, or severe for evaluation and treatment purposes. In this article, we will discuss the objective evaluation of the patient with melasma, as well as the treatments based on disease severity. Further recommendations for maintenance in these patients also will be addressed.