Melasma is more common in people with dark complexions and Fitzpatrick skin types III
IV.Depending on ethnicity and region, melasma prevalence might vary from 8.8% to 40%. The
cause of melasma is still unknown in the meantime.
Numerous elements, including genetics, sunshine, endocrine stimulation, oxidative
conditions,pregnancy, exogenous hormons,and morphofunctional changes, may have a role in
the development of the disease.
Since melasma is a common skin condition affecting mostly pregnant women and those on
hormonal birth control, it is known as the "mask of pregnancy,
Treatment for melasma remains a challenge, with substantial psychosocial ramifications.
Many factors, including variability in clinical presentation and responsiveness to
treatment between genders, skin phototypes, and ethnicities, can affect treatment
efficacy. None of variety methods have been sufficiently effective to be considered the
gold standard.
Hydroquinone (HQ) has historically been the most studied topical agent in the treatment
of melasma. HQ is a hydroxyphenolic compound that inhibits the conversion of dopa to
melanin by the inhibition of tyrosinase; it also inhibits RNA and DNA synthesis of
melanocytes and degrades melanosomes.
Tranexamic acid (TXA) is an antifibrinolytic drug that has been used off-label for the
treatment of melasma, as an oral or intradermal injection.
TXA is a lysine-derived amino acid with anti-inflammatory effects that prevents
ultraviolet (UV)-induced skin pigmentation by inhibiting attachment of plasminogen to
keratinocytes and activation of plasmin. Plasmin stimulates melanogenesis by conversionof
arachidonic acid to prostaglandin and leukotriene. On the other hand, plasmin increases
the level of melanogenic factors.
Laser therapy is a unique ablative modality that might potentially increase the
penetration of medications applied topically by destroying the SC, epidermal, and dermal
layers of the skin in a predictable and controlled manner.
The Fractional erbiumdoped yttrium aluminum garnet (Er: YAG) laser has a wavelength of
2,940 nm and is strongly absorbed by water in the epidermis. It exerts its ablation
effect with minimal penetration depth and minimal heat generation and therefore minimal
thermal damage.