Melasma/Pigmentation
About Melasma/Pigmentation
Melasma is a common acquired skin disorder that presents with bilateral, blotchy, brownish facial pigmentation. It is more common in women than men, and often presents between the ages of 20 and 40. Melasma is most common in darker skin types (Fitzpatrick phototypes III-V).
Factors implicated in development of melasma include:
Family history
Sun exposure
Hormones
Medications and scented products
Melasma is usually a clinical diagnosis based on the clinical appearance and examination with a Woods lamp and dermatoscope.
Other disorders may resemble melasma clinically including:
Post-inflammatory hyperpigmentation
Solar lentigos and other forms of lentigines and freckles
Acquired dermal macular hyperpigmentation
Drug-induced hyperpigmentation
Naevus of Ota and Hori’s macules
Treatment of Melasma
Melasma is often slow to respond to treatment and the pigmentation may not necessarily clear completely. Combination treatment is often used:
Year-long sun protection – SPF 50+ tinted moisturiser applied every 2-3 hours, broad-brimmed hat, sun-smart behaviour
Consideration of discontinuation of hormonal contraception
Cosmetic camouflage
Topical treatments including a prescription strength hydroquinone if appropriate
Some oral treatments
Chemical peels and lasers can be used with caution – they can carry a risk of worsening melasma or causing postinflammatory hyperpigmentation. Patients should be pre-treated with hydroquinone before embarking on these.