Melasma (Chloasma)
Melasma is an acquired hypermelanosis characterized by symmetrical, irregular, light-to-dark brown macules and patches, typically occurring on sun-exposed areas of the face.
Etiology & Risk Factors
- Hormonal Influence: Strongly associated with pregnancy (“mask of pregnancy”), oral contraceptive use, and hormone replacement therapy.
- Ultraviolet (UV) Radiation: UV exposure is the primary trigger that exacerbates the hyperpigmentation.
- Genetic Predisposition: More common in individuals with Fitzpatrick skin types III–VI.
Management Approach
| Strategy | Details |
|---|---|
| Sun Protection | Rigorous daily use of broad-spectrum SPF 50+ is mandatory. |
| Topical Therapy | Triple combination cream (Hydroquinone, Tretinoin, Fluocinolone) is the gold standard. |
| Chemical/Physical | Chemical peels or laser therapy (use with caution, as high-energy treatments may trigger post-inflammatory hyperpigmentation). |
High-Yield Exam Pearl:
- Woods Lamp Examination: Used to classify melasma by depth—Epidermal type enhances under Wood’s lamp, while Dermal type does not. Dermal melasma is significantly more resistant to treatment.
- Chronicity: Melasma is chronic and prone to recurrence; patient education regarding lifetime sun protection is crucial.