Melasma is a condition in which brown patches typically appear on the face, particularly on the cheeks, upper lip, jawline and forehead. Other body sites which may be affected include the forearms, nipples and genital regions. It tends to occur in young females and darker skin types. Of the cases of melasma, only 10% involve males. Adults frequently develop melasma in association with sunlight exposure and pregnancy—referred to as “chloasma,” the mask of pregnancy. Other associated risk factors include birth control pills, menopause, ovarian diseases, and hormonal imbalances. Another drug implicated in melasma is the anti-seizure medication, Dilantin. Although the melasma may improve after childbirth or after the discontinuation of the discontinuation of the offending medication, it may last up to many years. Patients seek treatment due to cosmetic dissatisfaction with their appearance.

Many topical treatments are available to treat melasma. First, and foremost, sunlight exposure should be avoided, and a complete sunblock with broad-spectrum UVA and UVB coverage should be applied daily. The cornerstone of therapy is the bleaching cream containing prescription-strength hydroquinone 4% applied twice daily to the affected areas. A potential side effect of hydroquinone is local exogenous ochronosis, which causes further skin darkening. Another effective remedy which may be used in conjunction with the hydroquinone is tretinoin cream. Other topical agents include azelaic acid, kojic acid, glycolic acid, cystamine and buthionine sulfoximine. Chemical peels, including glycolic acid peels, have been proven to be efficacious also. Laser treatments have also been utilized in the treatment of melasma, but may not be appropriate for all skin types due to the risk of postinflammatory hyperpigmentation.

by

Mary H. Lien, MD