MELASMA - ETIOLOGIC AND THERAPEUTIC CONSIDERATIONS

Background: Melasma is a common acquired symmetric hypermelanosis char acterized by irregular light- to gray-brown macules and patches involv ing sun-exposed areas of skin. Etiologic factors in the pathogenesis o f melasma include genetic influences, exposure to UV radiation, pregna ncy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Observations: Melasma is often a therapeutically challeng ing disease, and current treatments include hypopigmenting agents, che mical peels, and lasers. Hypopigmenting agents include phenolic and no nphenolic derivatives. Phenolic agents include hydroquinone and hydroq uinone combination preparations. Despite controversies regarding the i ssue 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 bleachin g agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in Lighter-complexioned patien ts. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety o f hyperpigmentary disorders, their precise efficacy and place in the t herapy of melasma have yet to be established. Conclusions: In the hier archy of therapies for melasma, the treating physician must consider t he devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.