Melasma. Etiologic and therapeutic considerations.
BACKGROUND
Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications.


METHODS
Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established.


CONCLUSIONS
In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.
D000279:Administration, Cutaneous; D002615:Chemexfoliation; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003998:Dicarboxylic Acids / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007641:Keratolytic Agents / Q000627:therapeutic use; D053685:Laser Therapy; D008297:Male; D008548:Melanosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D014212:Tretinoin / Q000627:therapeutic use; D014481:United States; D014486:United States Food and Drug Administration
D003879:Dermatologic Agents; D003998:Dicarboxylic Acids; D006873:Hydroquinones; D007641:Keratolytic Agents; D014212:Tretinoin; C010038:azelaic acid; C031927:hydroquinone