Melasma is a chronic acquired hypermelanosis of the skin, characterized by irregular brown macules symmetrically distributed on sun-exposed areas of the body, particularly on the face. It is a common cause of demand for dermatological care that affects mainly women (especially during the menacme), and more pigmented phenotypes (Fitzpatrick skin types III-V). Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Its pathogeny is not yet completely understood, although there are some known triggering factors such as sun exposure, pregnancy, sexual hormones, inflammatory processes of the skin, use of cosmetics, steroids, and photosensitizing drugs. There is also a clear genetic predisposition, since over 40% of patients reported having relatives affected with the disease. In this manuscript, the authors discuss the main clinical and epidemiological aspects of melasma.

Facial melasma is independently associated with elements linked to pigmentation capacity, family ancestry, chronic sun exposure, sexual hormone stimuli, psychotropics and anxiety traits.

Basal keratinocytes from facial melasma display changes in nuclear form and chromatin texture, suggesting that the phenotype differences between melasma and adjacent facial skin can result from complete epidermal melanin unit alterations, not just hypertrophic melanocytes.

There are few populational studies to estimate the dimension of dermatological diseases. We performed a survey with 515 employees from UNESP campus, Botucatu (SP), exploring demographic data, medical appointments and dermatological diagnoses. Additionally, we induced questions about prevalent diseases. Appointments to the dermatologist were reported by 77% of subjects. The main dermatoses spontaneously reported were mycoses, allergies, nevi and viral warts. There were association of juvenile acne and males (OR=2.3), melasma and females (OR=8.0), and onychomycosis with older age (OR=1.05). Surveys are important to know the demand for dermatology care, besides directing formulation of public health policy and medical education.

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Melasma is a chronic acquired focal hypermelanosis localized on sun-exposed areas that commonly affects females during their fertile years. Despite many known risk factors as cumulative sun exposure, oral contraceptive pills, pregnancy, stress, cosmetics, and some drugs, the physiopathology of melasma is not yet fully understood, which limits the development of definitive treatments and prevention strategies. Family occurrence (40-60%) is an evidence of genetic predisposition. Here, we discuss the role of sun protection, topical bleachers, light technologies, peelings, and oral strategies on therapeutic approach of melasma. Moreover, prognostic factors are pointed out.

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