Melasma: insights and perspectives

Melasma is a common disorder in women of reproductive age with darker skin tones, but may also affect adolescents, older women on certain medications, and sometimes men. It usually appears as hyperpigmented macules and patches distributed symmetrically on the face, neck and rarely the upper limbs. Although its pathogenesis remains unclear, known risk factors include ultraviolet (UV) radiation, hormonal variations of pregnancy and thyroid disease, and anti-seizure medications. The increase in melanin may be due to both an increase in melanogenesis and melanocytosis. Prevention should target a reduction of exposure to risk factors, such as consistent protection against UV radiation. The principle treatment options include topical hypopigmenting agents, chemical peels, laser therapy and superficial dermabrasion. The impact of melasma on the quality of life of patients should be considered.