The term “melasma” originates from the ancient Greek word melas, meaning “black.”
Melasma is a fairly common pigmentation disorder of the skin, characterized by an excess of melanin in the epidermis and the upper dermis (within macrophages). It is an acquired skin discoloration affecting the tone of the skin.
Clinically, it presents as macules or patchy plaques with irregular borders, ranging in color from light to dark brown.
The most common site of melasma is the face, but it can also appear on sun-exposed areas such as the neck and hands. Melasma occurs more frequently in women with darker skin tones and tends to worsen during the summer months. Depending on the exact location, it is classified into three types:
- Centrofacial (the most common type, affecting the forehead, cheeks, nose, upper lip, and chin)
- Malar (cheeks and nose)
- Mandibular (along the jawline)
Additionally, based on the depth of melanin deposition, melasma is classified into four types:
- Epidermal (increased melanin in the epidermis; the melasma appears more prominent under Wood’s lamp examination)
- Dermal (presence of many melanophages throughout the dermis; no enhancement of pigmentation under Wood’s lamp)
- Mixed type (a combination of the above: increased melanin in the epidermis and many macrophages in the dermis; Wood’s lamp reveals areas with enhanced pigmentation, some with reduced pigment, and others with no change)
Indeterminate type (seen in Fitzpatrick skin types V–VI).
The exact cause of melasma has not been fully clarified.
However, several factors appear to play a significant role, such as:
- Exposure to ultraviolet radiation (sunlight or artificial UV radiation)
- Dark skin tone
- Heredity
- Estrogen (pregnancy, contraceptive pills, or other hormonal treatments)
- Thyroid disorders
Melasma tends to appear or worsen during the summer months and improve during the winter.
It can be managed either conservatively with the topical application of appropriate products and formulations, or in combination with the use of laser devices. Treating melasma is a time-consuming process that often requires repetition and patience from the patient, as it frequently recurs.
Dr. Sotiris Theocharis selects the most suitable, individualized treatment plan, always tailored to the patient’s specific needs. This plan typically includes a combination of therapies for more effective melasma management, such as topical depigmenting agents (Kligman’s formula), the Fractional Erbium:YAG laser, antioxidant serums, mesotherapy with depigmenting agents (e.g., glutathione), and PRP.
A patient with melasma must understand that proper use of sunscreen and other photoprotective measures not only helps prevent new lesions from forming but also prevents worsening of existing ones.
Therefore, the most important product to apply is a high-protection sunscreen, all year round. It must be applied correctly, with reapplication every two to four hours. Additionally, after completing treatment, the dermatologist recommends the use of special products to maintain the results long-term and prevent recurrence.
It is very important for patients with melasma to understand that some cases are very persistent, and in those, we achieve improvement but not complete elimination of the problem. This mainly occurs with older, diffuse discolorations where the pigmentation is located in the deeper layers of the skin.
Improvement in the clinical appearance of melasma results from a combination of treatments that require a long period, repetition, and consistent cooperation with the treating dermatologist. Unfortunately, melasma can often recur or even become more intense, which is why systematic use of sunscreen throughout the year is essential.