Melasma is an acquired hyperpigmentation that mainly affects the face. It is more common in women of reproductive age, darker skin types such as Hispanics, Latinos, Asians and Africans. It can be caused by excessive melanin (pigment) deposition in the epidermis (more superficial zone of the skin) or dermis (deeper).

Female sex hormones are thought to play a role in melasma.

Pregnancy and the use of oral contraceptive pills are triggering factors¹.

Treatment

No single therapy works in all patients.

Sunscreen

UV and visible light can induce melanin (pigment) formation and cause or worsen melasma. Sunscreen with an SPF of >30 (UVB) and UVA rating of >3 stars is recommended on a daily basis (lifetime), in addition to sun avoidance. Use of sunscreen prevents melasma and enhances the efficacy of other treatments.

Combination Therapy

One of the most effective topical (cream) treatment is a combination of hydroquinone 4% (bleaching agent), 0.05% tretinoin (vitamin A) and 0.01% fluocinolone acetonide (cortisone) nightly for a minimum of 8 weeks.

Side effects include redness, desquamation (peeling), burning, dryness and itching. The frequency of application can be decreased if this occurs.

Hydroquinone can cause a bluish-gray discoloration known as ochronosis especially in South African Blacks.

Chemical Peels

These can be added to the combination therapy cream regimen however they do not improve the results very much. The only recommended chemical peel is the glycolic acid, however it can cause hyperpigmentation (dark spots on the skin similar to melasma).

Lasers

Lasers such as the Q-switched ruby laser and the erbium-YAG laser worsen melasma.

CO2 laser do not improve melasma.

Fractional resurfacing laser have shown benefit in improving melasma.

Intense Pulse Light (IPL) has shown modest benefit in improving melasma.

Laser should only be used if other options have failed².