Melasma

Melasma :
It is a pigmentory disorder characterised by brownish Macules  over face especially cheeks and forehead.
Types:
1) Epidermal
2) Dermal
3) Mixed
Depending on the level of pigmentation into the skin.
Another classification is based on the location of skin affected
1) Malar
2) Mandibular
3) Centrofacial

Woods light is used to determine the type of melasma.
 Cause:
1)Increased estrogen levels in females especially pregnancy
2) prolonged sun exposure

When it happens after or during pregnancy it's called chloasma (pregnancy mask).

How to treat??
1) Topical treatment
2) Systemic
3) Laser or light therapy
4) Chemical peel

1) Topical treatment:
A) Depigmenting agents:
1) Kojic acid
2) Mulberry extract
3) Hydroquinone 4%

B) Retinoids
C) Steroids
Most  common topical treatment :

Kligman formula (Triple combination formula):
Hydroquinone+ tretinoin+ fluocinonide


1) Systemic treatment:
a) Capsule vitamin c 200mg 1OD for 2-3 months.
b) Tab tranexamic acid 250-500 mg 1OD

2) Lasers:
Nd Yag laser toning 1064 nm is good for maintenance.
Intense pulsed light therapy is another alternative.
3) Chemical peel:
a) Glycolic acid peel 30%

Peeling procedures have downtime so most of the patients don't prefer.


Mesotherapy with tranexamic acid is also tried in some centres.

Recurrence rate is high with any above treatment.
No standard treatment is available. It is all depends on individual skin type.

Advice :
1) Use of sunscreen with spf 50+ and UVA+++
2) Use of wide brimmed hat in mid-day sun
3) Use of retinoids at night time