Melasma

Melasma (from the Greek word, melas. meaning black) is a common, acquired, circumscribed hypermelanosis of sun-exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. The most common locations are the cheeks, upper lips, the chin, and the forehead, but other sun-exposed areas may also occasionally be involved. The term chloasma (from the Greek word, chloazein. meaning to be green) is often used to describe melasma developing during pregnancy; however, as the pigmentation never appears to be green, the term melasma should be preferred. By wood’s light examination; melasma can be classified into epidermal, dermal or mixed typeThe precise cause of melasma is unknown; however, multiple factors have been associated with the etiopathogenesis of this condition. These factors include genetic influences, exposure to UV radiation, pregnancy, use of oral contraceptives, hormonal replacement therapies for menopause, thyroid dysfunction, use of cosmetics, and use of phototoxic and antiseizure drugsMelasma treatment remains a challenge for dermatologists. Multiple treatment modalities have been employed with variable results.Therapies for these conditions include topical agents, chemical peels, micro-dermabrasion, lasers and intense pulsed light. The topical agents include hydroquinone, kojic acid, azelaic aid, mequinol, and retinoidsChemical peels have become established as the treatment of choice in melasma especially in lighter complexioned individuals. Chemical peeling can be a modality to remove excess epidermal pigment in the epidermal and mixed types of melasmaChemical peeling agents include glycolic acid, tricloroacetic acid, jessner’s solution (lactic acid, salicylic acid, resorcinol, and ethanol), salicylic acid, tretinoin, kojic acid and pyruvic acidPyruvic acid has been used as a medium depth chemical peeling agent. It has proven its efficacy for the treatment of many dermatological conditions such as acne, superficial scarring, photodamage and pigmentarey disorders.Mesotherapy is used in the treatment of hyperpigmentation and melasma technique consists of intradermal or subcutaneous microinjection of a highly diluted drug mixture or of a single product at the sites of the body having medical problem. The compound injected into the mesoderm during mesotherapy depends upon the pathophysiology of the disease process. The materials used in the injection are tranexamic acid, arbutin, vitamin c, glycolic acid and glutathione