Melasma
Also known as: Chloasma, Mask of Pregnancy
Description
Melasma is an acquired pigmentary disorder characterised by symmetric brown to grey-brown patches on sun-exposed areas of the face. It is particularly common in women of reproductive age and in Fitzpatrick skin types III–V. UV exposure and hormonal factors (pregnancy, oral contraceptives) are key triggers.
Symptoms
- Symmetric brown or grey-brown macules and patches
- Most common on cheeks, forehead, upper lip, chin
- Worsens with sun exposure
- No associated itching or pain
- Significant cosmetic and psychosocial impact
Causes & Triggers
- UV radiation (primary trigger)
- Hormonal influences (oestrogen, progesterone)
- Genetic predisposition
- Visible light and heat exposure
- Certain medications (phototoxic drugs)
Severity Classification
Treatment Ladder
- 1 Foundational: Strict broad-spectrum sunscreen (SPF 50+) + visible light protection
- 2 First-line: Triple combination cream (hydroquinone + tretinoin + steroid)
- 3 Alternatives: Azelaic acid 15–20% or tranexamic acid (oral/topical)
- 4 Adjuncts: Vitamin C, niacinamide, glycolic acid peels
- 5 Refractory: Chemical peels, microneedling, or laser (with caution in darker skin)
Relevant Compounds
Alpha Arbutin
Tyrosinase inhibitor for gradual depigmentation
Alpha arbutin is a biosynthetic glycosylated hydroquinone derivative that inhibits melanin productio…
Azelaic Acid
Tyrosinase inhibitor — depigmenting with anti-inflammatory action
Azelaic acid is a naturally occurring dicarboxylic acid produced by Malassezia furfur. It has antiba…
Coenzyme Q10
Antioxidant — supports cell renewal
Coenzyme Q10 (ubiquinone) is a naturally occurring lipid-soluble benzoquinone that is present in vir…
Glycolic Acid
Superficial peeling agent — enhances penetration of depigmenting agents
Glycolic acid is the smallest alpha hydroxy acid with the greatest bioavailability due to its low mo…
Kojic Acid
Copper chelation to inhibit tyrosinase
Kojic acid is a natural metabolite produced by several species of fungi (Aspergillus, Penicillium). …
Niacinamide
Inhibits melanosome transfer to keratinocytes
Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…
Retinol
Milder retinoid for maintenance therapy
Retinol is an over-the-counter retinoid and a precursor to retinoic acid (tretinoin). It must be con…
Tretinoin
Accelerates epidermal turnover and disperses melanin
Tretinoin is a first-generation retinoid derived from vitamin A. It is one of the most extensively s…
Vitamin C
Tyrosinase inhibitor to reduce melanin synthesis
Vitamin C is a potent water-soluble antioxidant essential for collagen synthesis. In topical skincar…
Vitamin E
Antioxidant — photoprotection adjunct
Vitamin E is a fat-soluble antioxidant vitamin and a key component of the skin's natural antioxidant…
Recommended Drugs
Suggested Cosmetics
Lifestyle Tips
- Sunscreen is THE most important intervention — reapply every 2 hours outdoors
- Use tinted sunscreen with iron oxides for visible light protection
- Avoid waxing the face during active treatment
- Be patient — visible improvement takes 8–12 weeks minimum
- Hormonal review if linked to oral contraceptives
When to Refer
- Refractory melasma not responding to 6 months of topical therapy
- Consideration of procedural interventions (peels, laser)
- Diagnostic uncertainty (rule out post-inflammatory hyperpigmentation, lichen planus pigmentosus)