Melasma

Excerpt

Melasma is a common acquired hyperpigmentation disorder characterized by symmetric, irregularly bordered brown-to-gray macules and patches that predominantly involve sun-exposed facial skin (see Image. Melasma of the Midface and Lower Face). Commonly affected regions include the centrofacial, malar, and mandibular areas. Extrafacial involvement has also been described, particularly in individuals with chronic sun exposure.

Melasma is widely regarded as a chronic, relapsing pigmentary disorder in which long-term disease control and prevention of recurrence are as important as initial pigment clearance. Clinical improvement is frequently transient in the absence of sustained photoprotection and maintenance therapy, a characteristic that distinguishes melasma from other acquired hyperpigmentation disorders. Contemporary pathogenic models emphasize that melasma extends beyond isolated melanocyte hyperactivity and involves complex interactions among keratinocytes, fibroblasts, endothelial cells, inflammatory mediators, and the dermal extracellular matrix.

These insights have reframed melasma as a disorder characterized by overlapping features of photoaging, vascular dysregulation, and altered dermal signaling, rather than as a purely epidermal pigmentary condition. Given its facial predilection and chronic course, melasma is associated with substantial quality-of-life impairment, including emotional distress, social embarrassment, and reduced self-esteem. Results from recent studies using validated instruments demonstrate that disease severity does not consistently correlate with patient-perceived burden, reinforcing the importance of individualized counseling and expectation management.