How to Manage Melasma

Melasma, previously known as chloasma, is a commonly acquired hypermelanosis characterized by symmetric, reticulated, hyperpigmentations of sun-exposed areas of the skin, particularly the face. Melasma has a higher prevalence in women and patients of darker skin tones, although it can occur in all skin types. The dyspigmentation caused by melasma often has a negative psychosocial impact on those affected with the condition as demonstrated by patient-reported anhedonia, decreased self-esteem, dissatisfactory mood, and impairment in social and occupational functioning. 1 The pathogenesis of melasma is still unclear, however various factors have been implicated and well supported such as ultraviolet radiation exposure, genetic predisposition, and hormonal influences. 2 Due to the incomplete understanding of its pathogenesis and the high recurrence rate, melasma remains a difficult disorder to manage resulting in physician frustration and patient dissatisfaction. Nevertheless, several topical, oral, and procedural treatment options are available with varying mechanisms of action addressing the multifactorial nature of the disorder. The purpose of this article is to provide a framework for dermatologists to use to approach and clinically manage this common, yet therapeutically challenging, condition.