Melasma is a dermatologic condition that causes brown or gray patches to appear on the skin, typically on the face, neck, chest, and arms. It is a chronic condition that can recur with re-exposure to UV light. Melasma affects people of all skin types and tones, but it is more common in individuals with darker skin tones, including Asian, Hispanic/Latino, and Black.
“The Many Faces of” is a series of images showcasing some of the most commonly seen dermatology conditions in an array of skin tones. The images highlight nuances in clinical presentation and are part of The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas, a resource developed by co-editors Misty Eleryan, MD, MS, and Adam Friedman, MD, and published by SanovaWorks and Educational Testing & Assessment Systems.
As you can see from the images, melasma can affect any skin type and tone, though it may be more appreciable in lighter skin tones due to the wider contrast between unaffected background skin and the melasma patches. Melasma is an acquired condition most often appearing as confluent hyperpigmented macules and patches with the classic “moth-eaten appearing borders” in photo-exposed areas.
Treatment for melasma includes topical lightening creams that contain hydroquinone, azelaic acid, kojic acid, ascorbic acid, and cysteamine. Oral and topically compounded tranexamic acid has also been utilized for the treatment of melasma and hyperpigmentation. Various procedural treatments that have been successful include chemical peels, micro-needling, intradermal injections, and laser therapy.
Regardless of the treatment(s) choice for melasma, it is important to educate patients that melasma is a chronic condition that often recurs, especially with re-exposure to UV light. Photoprotection is a vital step with any treatment, with preference for mineral-based sunscreens SPF30+ containing titanium or zinc. Tinted sunscreens with iron oxide are also preferred specifically for melasma as they help to block visible light, which is also a known exacerbating factor of melasma.
