What it means for a patient
- Pregnancy, hormone therapy, sun exposure, some cosmetics and some medicines are linked to melasma.
- Hydroquinone was the most effective approved bleaching cream at the time of the review.
- Chemical peels call for caution in darker skin, per the author.
- The role of lasers in melasma was unproven when this review was written.
- The author treats the emotional effect of skin darkening as part of the treatment decision.
- This is a review. It reports no new patient data.
Why this paper matters
It set out the causes of melasma and named hydroquinone the most effective FDA-approved topical bleaching agent.
Overview
Melasma is a common acquired darkening of sun-exposed skin in symmetric, irregular light-brown to gray-brown spots and patches. The author reviews its causes and its treatments: bleaching agents, chemical peels and lasers. Melasma is described as often difficult to treat.
Findings
- Causes named: genetic influences, UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs and antiseizure medicines.
- Current treatments: hypopigmenting agents, chemical peels and lasers.
- Phenolic agents: hydroquinone and hydroquinone combination preparations.
- Despite controversy about hydroquinone-induced ochronosis, hydroquinone remains the most effective topical bleaching agent approved by the FDA for melasma.
- Nonphenolic agents: tretinoin and azelaic acid.
- Superficial, medium and deep chemical peels are used more often in lighter-skinned patients and should be used with caution in Black patients.
- Lasers have shown efficacy in several hyperpigmentation disorders, but their efficacy and place in melasma treatment are not yet established.
- The author states that the treating physician must weigh the psychosocial impact of pigment problems against the benefits and risks of each treatment.
- The abstract gives no patient numbers.
Terms
- Melasma: patchy brown or gray-brown darkening of sun-exposed skin, mostly on the face.
- Hypermelanosis: darkening of the skin from extra melanin pigment.
- Macule: a flat, discolored spot on the skin.
- Hypopigmenting agent: a product that lightens skin color.
- Hydroquinone: a cream that lightens dark skin patches.
- Ochronosis: a blue-black darkening of the skin that can follow long-term hydroquinone use.
- Tretinoin: a vitamin A cream that speeds skin cell turnover.
- Azelaic acid: a cream used to lighten pigment.
- Chemical peel: an acid applied to the skin to remove its outer layers.
- Phototoxic drug: a medicine that makes skin react to sunlight.