Melasma: a clinical and epidemiological review

Abstract

Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.

FIGURE 1

Mixed melasma. Female patient with frontal, temporal, parotid, mandibular, zygomatic, mentonian lesions and lesion in the upper lip

FIGURE 2

Extra-facial melasma. Brown pigmentation in the neck area, an area of sun exposure due to the neckline

FIGURE 3

Comparison between photography with visible light (top) and with the use of Wood's lamp (bottom) highlighting the limits of the frontal macules of melasma

FIGURE 4

Dermoscopy (polarized light) of transitional area: frontal melasma (left) and healthy skin (right). We can observe brown pigment and more intense telangiectasies in the affected area, forming an irregular network