Review article
Melasma – Updated Treatments
Mirna Šitum
Maja Kolić
Željana Bolanča
Ivana Ljubičić
Bernarda Mišanović
Abstract
Melasma is a common, acquired facial skin disorder, mostly involving sun-exposed areas like cheeks, forehead and
upper lip. Melasma occurs in both sexes, although almost 90 percent of the affected are women. It is more common in
darker skin types (Fitzpatrick skin types IV to VI) especially Hispanics/Latinos, Asians and African-Americans. The onset
of the melasma is at puberty or later, with exception of darker skin types, who tend to develop this problem in the first
decade of life. The etiology is still unknown, although there are a number of triggering factors related to the onset of
melasma. The most important are sun-exposure and genetic factors in both sexes, while hormonal activity has more important
role in females. In addition, stress and some cosmetic products and drugs containing phototoxic agents can
cause outbreaks of this condition. Melasma should be treated using monotherapies or combination of therapy, mainly
fixed triple or dual combinations containing hydroquinone, tretinoin, corticosteroids or azelaic acid. Modified Kligman’s
formula is also very effective. Above mentioned therapy regimens in combination with UVA and UVB blocking
sunscreens are mostly effective in epidermal melasma. Discontinuation of the use of birth control pills, scented cosmetic
products, and phototoxic drugs coupled with UV protection are also benefitial in clearing of melasma. Alternative treatment
including chemical peels and glicolic acid, seem to have the best result as a second line treatment after bleaching
creams. Laser treatments show limited efficacy and should rarely be used in the treatment of melasma. Combining topical
agents like hydroquinone, tretinoin and a corticosteroid in addition to sun avoidance, regular use of sunscreen throughout
the year and patient education is the best treatment in this difficult to treat condition.
Keywords
melasma; hyperpigmentation; hydroquinone; tretinoin; corticosteroids; fotoprotection
Hrčak ID:
72300
URI
Publication date:
25.9.2011.
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