Management of Melasma: Emerging Facts

Melasma is a dark or tan discoloration of the skin, whose exact cause is still unclear however sun exposure, hormonal influences, phototoxic drugs, and genetic factors are some of attributing factors. It is more common in females; with an 80% distribution is Centro-facial. Pathophysiologically, melasma shows the surge in dermal and epidermal pigmentation along with melanosomes, perivascular lymphohistiocytic infiltrates, and expansion of melanocytes. The latest treatment regimens include oral, topical, and procedural therapies. Conventional treatment of melasma includes hydroquinone, tretinoin, corticosteroids, and triple combination creams; Tranexamic acid, Polypodium leucotomos, and glutathione are newer drugs that have shown propitious effects. Techniques such as chemical peels, micro-needling, radiofrequency, and laser are also widely used as first-line or complementary treatments for melasma. Combing different treatment modalities have shown better efficacy than monotherapy. The objective of this review is to update the current emerging treatment modalities of melasma.