Melasma, an acquired disorder of hyperpigmentation, has long frustrated those it affects and the health care professionals who attempt to treat it. Its cause is not clear, but exposure to UV radiation (especially UVA), heat, and visible light all appear to play roles, as do female hormones. Existing treatments lighten the skin through inhibition of melanin synthesis, reduction of melanin, and disruption of melanin granules.
The authors attended a roundtable discussion group and discussed a therapeutic approach to melasma in an effort to render analysis and recommendations for its treatment and management. The summary of discussion and information presented at this meeting is detailed within this article. In general, the authors opined that, while a variety of monotherapies, including hydroquinone, retinoids, and kojic and azelaic acids, have been used to treat melasma, the best results appear to be obtained with combination therapy in a program of sun protection and elimination of exogenous estrogens. Other effective adjunctive treatment modalities include microdermabrasion, chemical peels, and laser and light therapies. The concluding result of their discussion and presentation as presented within this article is a practical stepwise treatment approach for the treatment of mild, moderate, severe, and resistant melasma.