Melasma in Diverse Skin Types: Treatment Approaches

Overview / Definition Melasma, also known as chloasma or "mask of pregnancy," is a common acquired disorder characterized by symmetrical, hyperpigmented macules and patches, primarily located on the face. It predominantly affects individuals with darker skin types, particularly those of Hispanic, Asian, and African descent. Melasma is often exacerbated by sun exposure and hormonal changes. Epidemiology Melasma has a significant prevalence among women, especially during their reproductive years. The incidence of melasma varies globally, with the highest rates reported in populations with darker skin types. Prevalence: Approximately 15-50% in women of reproductive age. Gender: Predominantly affects women (90% of cases). Ethnicity: More common in individuals of Hispanic, Asian, and African descent. Pathophysiology / Mechanism The exact mechanism of melasma remains unclear, but several factors contribute to its development: Hormonal influences: Estrogen and progesterone are linked to melasma, particularly during pregnancy or with hormonal contraceptive use. Ultraviolet (UV) radiation: UV exposure stimulates melanogenesis, aggravating melasma. Genetic predisposition: Family history may play a role in susceptibility. Inflammation: Post-inflammatory hyperpigmentation from dermatologic procedures or skin conditions can lead to melasma. Clinical Presentation Melasma typically presents as: Symmetrically distributed brown or grayish-brown macules. Commonly found on the cheeks, forehead, nose, and chin. Less commonly, melasma can affect the neck and forearms. It is important to differentiate melasma from other forms of hyperpigmentation, such as: Post-inflammatory hyperpigmentation Solar lentigines Drug-induced hyperpigmentation Diagnosis / Workup The diagnosis of melasma is primarily clinical. A thorough history and physical examination should be performed, focusing on: Duration and extent of hyperpigmentation. Sun exposure history. Hormonal influences (e.g., pregnancy, contra