Melasma. Classification and treatment

Melasma is a cosmetic problem that sometimes causes great emotional suffering. The two most important causative factors are sunlight and genetic predisposition. Moreover, natural and synthetic estrogens, the use of certain drugs and the use of cosmetics with certain components have been implicated as etiologic factors. For the treatment of melasma, the elimination of the factors that are associated with the abnormality of pigmentation, is essential (discontinuation of birth control pills, avoidance of sun exposure). From the many medications that have been used in the treatment of melasma, Hydroquinone alone at a concentration of 2-5%, or in combination with tretinoin or tretinoin and corticosteroids, is now the most widely used preparations. New phenolic compounds and Azelaic acid are also used. Medium depth chemical peeling alone or in combination with other bleaching agents has also been tried with success in some cases. Finally, the use of lasers is discussed.