Current Views on Melasma

Melasma is a common acquired hyperpigmentary disorder of the face mostly in women with darker skin types. Chronic sun exposure, genetic influences, and female sex hormones have been addressed as major etiological factors. The pathogenesis of melasma is not fully understood, but current studies suggest that endogenous or exogenous stimuli may stimulate the microenvironment, leading to the release of various mediators that activate melanocytes in the development of melasma. In melasma skin, not only melanocytes but other actors, especially dermal components such as photoaged fibroblasts or vasculature, most likely play a key role in the development and in relapses of melasma. Treatment of melasma is difficult because it is recalcitrant to therapy and frequently recurs, even after successful clearance. There are various treatment options, usually in combination with topical depigmenting agents, laser or light therapies, as well as systemic tranexamic acid.