Cosmetic Concerns in Melasma, Part 1: Pathogenesis and Clinical Considerations

Melasma is a chronic acquired skin condition, characterized by irregular brown or hyperpigmented patches that commonly occur symmetrically on the forehead, cheeks, and nose. The pathogenesis of melasma, although not fully elucidated, is believed to be multifactorial. Exposure to UV light and heat, hormonal changes, and genetic factors are thought to play interconnected roles in the development of the disease. Although all skin types are susceptible to melasma, patients with darker skin phototypes are more commonly afflicted. Melasma also can impact a patient’s overall quality of life (QOL) and can be distressing for both patients and physicians because the disease often is refractory to treatment. As a result, treatment methods must address clinical outcomes as well as the patient’s psychological health and QOL. In part 1 of this series, we review the pathogenesis, clinical aspects, and psychological/ emotional impact of melasma.