Etiology and pathogenesisEtiopathogenesis of melasma is multifactorial and remains unclear. Genetic and hormonal factors and exposure to UV radiation are classical influencing factors. There are many other factors that may play a role in the etiology of melasma, such as ingredients in cosmetics, phototoxic and anti-seizure drugs, endocrine disorders (ie, ovarian or thyroid dysfunction), hepatic dysfunction, parasitoses, and nutritional deficiency. It is important to note that most cases of melasma in men and up to one third of cases in women are idiopathic (5).Ultraviolet exposure is a major triggering and aggravating factor in the development of melasma, since it has a well known ability to stimulate proliferation of melanocytes, their migration, and melanogenesis (1). However, UV-induced hyperpigmentation usually recovers spontaneously, whereas melasma does not.
Recently, Kim et al. detected down-regulation of the
AbstractMelasma is a common cosmetic problem and its severity ranges from minor pigmentation during pregnancy that resolves spontaneously, to a chronic, troublesome, disfiguring condition. Today, there are various treatment modalities for melasma, providing a different success rate. The need for an effective treatment for melasma is becoming more and more significant probably due to the current lifestyles with increased UV exposure, broad use of hormones for contraception and hormone replacement therapy, as well as increasing esthetic demands. The mainstay of treatment is regular use of sunscreens along with topical medications suppressing melanogenesis. This review summarizes recent progress in understanding the pathophysiology of melasma and implications for new treatment strategies.