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Melasma: Aetiology and Treatment Review

Melasma is a chronic acquired condition that results in the hyperpigmentation of the skin. It predominantly affects the sun-exposed sites of the face, although it can appear elsewhere on the body. Melasma has a significant effect on the quality of life of its sufferers and, although it is a common skin condition, no hyperpigmentation treatments yet exist that are effective, sustainable and reproducible – a frustration for both practitioners and patients alike.

Melasma commonly occurs in women during their reproductive years. It appears that pregnancy and the use of oral contraceptives that contain oestrogen are heavily implicated in the pathogenesis of melasma; this is due to oestrogen mediated melanocytic stimulation. The condition is also more common in darker skinned individuals and there is a high incidence of melasma in family members, suggesting a possible genetic predisposition.

It seems the major triggering factor and subsequent aggravating factor for this condition is ultraviolet light, which stimulates an increase in both melanocytic hyperplasia and melanosome production. There is some controversy as to whether topical cosmetics and fragrances can induce melasma, with some studies suggesting these products can trigger photocontact dermatitis – a known precursor for melasma.

All treatments currently on the market have a high relapse rate. It is therefore critical that both practitioners and their patients have realistic expectations about the efficacy of treatment to avoid disappointment. With a common skin condition such as melasma, there is no doubt that more research is needed to consider other treatment modalities as well as maintenance treatments to provide a more sustained solution.


Source: PRIME Journal
Cliff, S. & Cliff-Patel, N (2017). Melasma Aetiology & Treatment Review. PRIME Journal, Vol. 7, Issue 3. P 24.

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