Melasma is a common pigmentary condition that presents as symmetric dark patche on the face. It typically affects women, can occur in men also. Genetic predisposition, ultraviolet (UV) radiation exposure, hormonal factors such as female sex hormones and thyroid disease, pregnancy are risk factors.
Significant association has been reported between thyroid autoimmunity and melasma, mainly in women whose condition developed during pregnancy, or after ingestion of OCPs.
UVA and visible light were able to increase pigmentation especially in patients with dark skin.
Melasma is classified into epidermal, dermal and mixed types based on the depth of pigmentation.
Hydroquinone (HQ) and triple combination creams (TCCs) remain the gold standard of treatment. There have been concerns about the side effects and long term safety of HQ.
Current treatment modalities include kojic acid, azelaic acid, arbutin, ascorbic acid, chemical peels and lasers.
Newer formulations that are being tried include tranexamic acid (TA), rucinol (4-n-butylresorcinol), oligopeptides silymarin and orchid extracts.
Various botanical extracts that have been tried in melasma are grape seed extract, pycnogenol, aloesin, green tea extracts, coffee berry, soy, and licorice extract.
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