Melasma update

Rashmi Sarkar, Pooja Arora, Vijay Kumar Garg, Sidharth Sonthalia, Narendra Gokhale, Rashmi Sarkar, Pooja Arora, Vijay Kumar Garg, Sidharth Sonthalia, Narendra Gokhale

Abstract

Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms "melasma, pathogenesis, etiology, diagnosis, treatment" and have included data of the last few years.

Keywords: Etiology; hydroquinone; lasers; melasma; pathogenesis; peeling; treatment.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Centrofacial melasma
Figure 2
Figure 2
Malar melasma
Figure 3
Figure 3
H and E, ×200 epidermis shows increased melanin concentration in basal keratinocytes and underlying solar elastosis along with dermal melanophages (Courtesy of Dr. Uday Khopkar, Mumbai, India)
Figure 4
Figure 4
Dermoscopy from left cheek melasma showing dispersed brownish spots. White hairs are due to bleaching
Figure 5
Figure 5
Dermoscopy from right cheek melasma showing dispersed brownish spots
Figure 6
Figure 6
Dermoscopy from right cheek melasma showing dispersed pigment and depigmentation
Figure 7
Figure 7
Dermoscopy from nasal melasma showing larger dispersed brownish spots
Figure 8
Figure 8
Dermoscopy from the surrounding skin revealing more steroid induced telangiectasias
Figure 9
Figure 9
Dermoscopy from surrounding normal skin revealing mild steroid abuse-induced telangiectasias
Figure 10
Figure 10
Confocal microscope images of melasma showing epidermal pigmentation: (a) Melasma on the cheek. L is for lesional skin and N is for normal perilesional skin. (b) Confocal images depict cobblestoning and loss of dermal papillary rings at the basal layer of the melasma lesion (L) compared to perlesional normal skin (N). Scale bar: 50 um. (c) Histopathology from same lesion showing greater epidermal hyperpigmentation and flattened rete ridges in lesion compared to perilesional normal skin Fontana-Masson staining, horizontal line indicates where reflectance confocal microscopy image is taken from (source acknowledged: Kang HY, Bahadoran P, Ortonne JP. Reflectance confocal microscopy for pigmentary disorders. Exp Dermatol 2010;19:233-9)
Figure 11
Figure 11
Confocal microscopy image of melasma showing dermal pigmentation: (a) Clinical picture of melasma. (b) Confocal microscopy showing bright plump cells in dermis. (c) Histopathology picture showing melanophages in the dermis (source acknowledged: Kang HY, Bahadoran P, Ortonne JP. Reflectance confocal microscopy for pigmentary disorders. Exp Dermatol 2010;19:233-9)

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Source: PubMed

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