A comprehensive review of melasma with an emphasis on various treatment options in patients with Fitzpatrick skin types III-V

Abstract

Melasma is an acquired, symmetric, hyperpigmentary condition mainly seen on the face. The pathogenesis of this condition is not clearly known but UV radiation exposure, hormonal changes and genetics play key roles in its etiology. It is seen in about 1% of the total general population, predominantly in women of reproductive age, and rarely in the pre-pubescent. Various scales have been developed to grade the severity of the disease and its psychosocial impact on the patient, as well as to aid physicians in determining the efficacy of different treatments. The current treatments of melasma are based on preventing various steps in the melanogenesis pathway, such as melanin synthesis and/or proliferation of melanocytes, and on enhancing melanosome degradation. Therefore, it is important to thoroughly understand the pros and cons of each individual modality of treatment to be able to tailor the best treatment option for the patient. Over the past few years, there have been many studies done on the treatments and outcomes of melasma. The aim of this work is to review the current literature on different treatment options for melasma and to suggest robust, evidence-supported guidelines for treatment.