Melasma
Symptoms
Melasma appears as symmetric hyperpigmented macules on sun‑exposed areas such as the cheeks, forehead, upper lip, and chin. Color ranges from light brown to dark gray‑brown. Lesions have irregular borders and become more pronounced with sun exposure. The condition is painless but cosmetically distressing. Pregnancy and hormonal contraceptives often exacerbate pigmentation.
Cause
Excess melanin production results from a combination of UV radiation, hormonal influences (estrogen, progesterone), and genetic predisposition. Heat and visible light also stimulate melanogenesis. Thyroid dysfunction and certain medications can contribute. Skin‑type IV‑VI individuals are more prone. Inflammation and oxidative stress sustain pigmentation.
Treatment
Strict photoprotection with broad‑spectrum sunscreen and sun‑avoidance is essential. Topical lightening agents such as hydroquinone, azelaic acid, or kojic acid inhibit melanogenesis. Combination therapy with tretinoin and mild corticosteroids enhances efficacy (triple cream). Chemical peels and laser treatments offer additional benefit but risk post‑inflammatory hyperpigmentation. Maintenance therapy and ongoing sun protection prevent relapse.
Dr. Beth Schulz-Butulis
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