Clinical Reference / Therapeutic Strategies / Facial Melanosis, Melasma

Facial Melanosis, Melasma


Key Points

  • Facial melanosis (also known as melasma) is a very common condition. In the USA, 5 to 6 million individuals are affected.
  • Melasma usually appears in association with oral contraceptive (OCP) use or pregnancy (“chloasma,” or the “mask of pregnancy”) and is exacerbated by sun exposure.
  • Although the pigmentation usually fades after pregnancy or withdrawal of OCPs, it may persist indefinitely. Melasma may become a chronic condition.
  • Melasma is more common in women than in men, accounting for 90% of cases.
  • Treatment of melasma involves topical drugs, superficial procedures (such as chemical peels), and photoprotection.
  • First-line treatment is a triple combination topical therapy, including hydroquinone, retinoid cream, and corticosteroids. When patients experience irritation to one of the ingredients or a triple combination is unavailable, other compounds with dual ingredients or single agents may be considered as an alternative.

Introduction

Melasma is a chronic condition of hyperpigmented patches that gradually develop on the face, especially on sun-exposed areas, on the forehead, zygomatic cheeks, nose, and upper cutaneous lip. It results from increased epidermal melanin pigment in the epidermis, dermis, or both; increased number of melanocytes or dermal melanophages in the dermis may also result in melasma. It usually appears in association with estrogen exposure in the form of oral contraceptive (OCP) use, hormone replacement therapy (HRT), or pregnancy (“chloasma” or the “mask of pregnancy”). Melasma is exacerbated by sun exposure. Although the pigmentation usually fades after pregnancy or withdrawal of OCPs, it may persist indefinitely; this chronic condition may have a significant psychosocial impact on quality of life.

Load more