1) Melasma is a skin condition caused by overproduction of melanin pigment.
2) The gray-brown patches can be on the face, neck or forearms where there is a significant sun exposure.
3) Persons of any race can be affected although darker skin types, particularly light brown skin types, are more affected.
4) The most important factor is exposure to sunlight.
5) Women are more prone to get melasma and is common during pregnancy called “The Mark of Pregnancy.”
6) Melanin is present in dermis, epidermis or both.
7) The dermal pigment may take longer to resolve than the epidermal pigment (because there is no effective therapy for dermal pigment reduction).
8) There is a 4-fold increase in thyroid disease in melasma patients.
9) Hormones seem to trigger melasma.
10) Birth control pills + hormone replacement therapies can also trigger melasma.
11) Some skin care products can worsen melasma (aggressive RF microneedling, deep peels or deep derma like waxing, microneedling).
12) Aggressive and abrasive skin procedures are shown to cause “post inflammatory hyperpigmentation.”
13) Ultraviolet rays from the sun cause increased pigmentation by stimulating melanocytes.
14) The source of dermal pigment is the epidermis. So, if epidermis pigment is controlled for prolonged time, dermal pigment will gradually resolve.
15) Evaluation of a person present with melasma starts with a good history, including medications, cosmetics used and supplements taken.
16) There are multiple treatment options including the following:
Topical: Azelaic Acid, Kojic Acid, Cysteamine Cream, Ascorbic Acid, Methimazole,Tranexamic Acid, Glutathione, Soy Bean Extract Hydroquinone Oral: TA
Procedures: Nd: YAG, IPL, Non-ablative fractionated, Peels (glycolic, mandelic, AHA, BHA), Salicylic Acid, Microneedling.
17) Patients should avoid routine use of cosmetics on sensitive skin.
18) Skin lightening topical creams and oral supplements work but pigmentation returns once treatment is discontinued.
19) Intra lesional micro needling of Tranexamic Acid may improve local tolerability of the drug with more even intradermal distribution.
20) Glutathione-by inhibiting Tyrosinase, reduces inflammation and increases pheomelanin instead of eumelanin, which lightens the skin.
a) 500mg orally, daily for 8 weeks has shown beneficial effects
b) 2% glutathione-topical for 10 weeks has shown beneficial effects
21) Nd:YAG laser is better absorbed by melanin. It also obliterates abnormal upper dermal vascular plexus and promotes collagen formation.
22) IPL: not recommended for darker skins.
23) The most important thing is to remember that treatment is a slow process usually taking several months based on the depth of pigment and the inciting factors.