Though a relatively common disease, melasma can be devastating for patients. The changes in pigmentation, particularly brown to gray-brown patches on the visible parts of the body (eg, face, neck, and forearms), can cause significant distress and impact quality of life. Its pathogenesis is complex, involving a number of factors including genetics, inflammation, oxidative stress, vascular response, and hormonal sensitivity, and treatment of melasma can require multiple therapies to address these factors.
“The most important thing I want people to realize is that melasma is a chronic skin disease,” explained Seemal R. Desai, MD, FAAD, a pigmentary specialist. He noted that melasma requires a multifactorial treatment approach and that one cream or medication alone is not going to be enough to take care of the entire condition.
“Secondly,” continued Dr Desai, “dermatologists need to understand that melasma is not just a cosmetic disease. It should be considered a chronic medical skin disease because we know that there are several different causes of melasma. It is not just an increase in the amount of pigment, but also related to an increasing amount of abnormal vascularity, potentially related to abnormal dysregulation in mast cells, and hormonal influences on the skin. It is really important we understand that there is more at play when it comes to melasma.”
Dr Desai explained that there are several developments surrounding the pathogenesis of the disease, but he further elaborated on a number of treatment options now available for patients.
“Of course, hydroquinone is still our gold standard workhorse in topical skin lightening. The new topical melasma treatments include ingredients such as tropical tranexamic acid, which is available in 2% or 3% concentrations either compounded or in cosmeceutical formulations,” he said.
“Also,” Dr Desai continued, “topical cosmeceuticals such as niacinamide and vitamin C have become very important in our therapeutic fight against hyperpigmentation. Another important aspect is the combination of these topical therapies with other off-label prescription ingredients, such as azelaic acid.”
Because of its frequent presentation in dermatology clinics, physicians should note of the latest advances in the treatment of melasma and other pigmentary disorders. “It is an important part of what we do in medicine for patients with skin of color,” said Dr Desai. “We need to be aware that one of the most common presenting chief complaints amongst patients with skin of color is pigmentary issues in a general dermatology clinic. It is important we are critically aware of this along with other conditions of hyperpigmentation.”