Melasma: Treatment strategy

Abstract

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Wood's lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2'-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.

[6]-Shogaol inhibits melanogenesis in B16 mouse melanoma cells through activation of the ERK pathway

“…Melanin content was then measured in the B16 cells under the www.chinaphar.com Yao C et al Acta Pharmacologica Sinica npg same treatment conditions. Kojic acid, a well-known melanogenesis inhibitor, was used as a positive control [19] . [6]-Shogaol reduced melanin content in a dose-dependent manner ( Figure 1B).…”

“…Therefore, much effort has been directed at the search for novel and effective whitening agents. As a result of melanin biosynthesis studies, kojic acid, arbutin, and many other natural products are now utilized selectively for the treatment of hyperpigmentation diseases in humans, such as melasma, freckling, and other dermatological disorders [19,20] . However, the recent discovery of their adverse side effects suggests that the applicability of these chemicals might be limited.…”

A review of laser and light therapy in melasma

“…An overview of topical melasma treatments was recently published by Ball Arefiev and Hantash (2012) and Sehgal et al (2011). Topical treatments may be unsatisfactory due to a lack of response, slow rates of improvement, or adverse events such as pseudo-ochronosis with hydroquinone or skin irritation, erythema, and postinflammatory hyperpigmentation (PIH; Ball Arefiev and Hantash, 2012, Sehgal et al, 2011).…”

A Comparison Study Between Image Analysis and Conventional Methods in the Evaluation of Asian Skin Color

“…Hyperpigmentation of the face is a common skin problem among middle-aged women, especially those with dark complexion [1]. Moreover, facial skin color distribution significantly influences the perception of age and attractiveness [2,3].…”