Melasma
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Melasma (chloasma) is a chronic skin pigmentation disorder characterized by symmetrical, irregular discolorations ranging from light brown to dark brown. These changes most commonly occur on the face—in areas such as the cheeks, forehead, upper lip, and nose—less frequently on the neck or décolleté. The condition is recurrent and primarily affects women, particularly those of reproductive age, indicating a significant role of hormonal factors. The pathogenesis of melasma is complex, involving excessive melanocyte activity, epidermal barrier dysfunction, vascular changes, and the influence of UV radiation and visible light. Melasma does not pose an oncological threat; however, due to its location and chronic nature, it significantly impacts the quality of life of patients.
Melasma – what is it
Melasma is a patchy skin hyperpigmentation, resulting from the overproduction of melanin and its abnormal deposition in the skin. Depending on the depth of the pigment deposits, it can be categorized into:
- epidermal melasma – located primarily in the basal layer of the epidermis,
- dermal melasma – with the presence of melanin in the dermis (melanophages),
- mixed melasma – the most commonly seen clinically.
Characteristic features of melasma:
- symmetrical distribution of the lesions,
- lack of inflammatory features,
- irregular, blurred borders,
- intensification of pigmentation under the influence of sunlight.
Melasma differs from other types of hyperpigmentation (e.g., lentigines or post-inflammatory hyperpigmentation) in its mechanism of formation, the depth of the lesions, and the response to treatment, which is crucial for selecting the appropriate therapy.
Melasma – causes
The causes of melasma are complex and multifactorial, and its development results from the interaction of internal and external factors. The most important include:
- pregnancy (known as chloasma gravidarum),
- oral hormonal contraception,
- hormone replacement therapy,
- endocrine disorders.
- exposure to UVB and UVA radiation,
- impact of blue light (HEV),
- lack of or improper photoprotection.
- positive family history,
- more frequent occurrence in Fitzpatrick skin types III–V.
- damage to the epidermal barrier,
- chronic skin irritations,
- use of irritating cosmetics or procedures,
- oxidative stress.
Currently, melasma is perceived not only as a disorder of melanogenesis but also as a condition associated with dysfunction of skin vessels, fibroblasts, and low-grade inflammatory processes, which explains its resistance to treatment.
Melasma – how to get rid of it
Complete and permanent removal of melasma is difficult, however, it is possible to significantly lighten the changes and reduce recurrences. A long-term and multi-directional approach is crucial.
Basic principles of management:
- Absolute photoprotection throughout the year (SPF, protection against visible light),
- Avoiding excessive sun exposure,
- Rebuilding and protecting the skin barrier,
- Eliminating triggering factors (if possible).
The effectiveness of the therapy depends on:
- The type of melasma (epidermal vs. dermal),
- The duration of the changes,
- The regularity of the therapy,
- Adherence to sun protection principles.
It should be emphasized that lack of photoprotection undermines even the most advanced treatment, and melasma tends to recur, especially upon re-exposure to UV or hormonal factors.
Melasma – Treatment
Treatment of melasma requires an individual therapeutic plan and often combination therapy. Management includes topical methods, procedural approaches, and preventive measures.
Therapeutic strategies employed:
- regulation of melanocyte activity,
- inhibition of melanin synthesis,
- acceleration of epidermal renewal,
- improvement of skin barrier function,
- reduction of vascular and inflammatory components.
In clinical practice, treating melasma is a long-term and stepwise process. Results appear gradually, and the goal of the therapy is not a one-time "removal of discolorations," but rather control of the condition and maintenance of stable improvement. Inappropriately chosen or overly aggressive procedures can lead to exacerbation of lesions or post-inflammatory hyperpigmentation, which is why treatment should be conducted in a controlled manner.
Treatments for melasma
Treatments used in the management of melasma aim to lighten existing discolorations, regulate melanogenesis, and improve skin quality, while simultaneously minimizing the risk of irritation.
The procedures used in melasma therapy include, among others:
- controlled laser and light treatments – targeting excess pigment and the vascular component,
- procedures utilizing thermal energy with a low risk of inflammation,
- treatments supporting skin regeneration and epidermal barrier,
- combined therapies, conducted in stages with regenerative breaks.
In the treatment of melasma, the following are key:
- proper patient qualification,
- assessment of the depth of discolorations,
- selection of procedures with a documented safety profile,
- strict adherence to post-procedure recommendations, especially regarding sun protection.
Melasma remains one of the most challenging pigmentary disorders in dermatology, so effective treatment is based on pathophysiological knowledge, clinical experience, and a consistent, long-term therapeutic approach.
