ISSN: 2574-7800
Authors: Lenz CR* and Aldrich SL
Melasma is a commonly acquired hyper-melanotic condition characterized by brown to grey colored irregular macules and patches on sun-exposed surfaces of the skin, most commonly on the malar prominence and forehead. It is most common in females, generally of childbearing age, and especially prominent in darker skinned individuals, particularly those of Asian descent. Chronic ultraviolet (UV) light exposure, genetic factors and reproductive hormones are generally accepted to be contributing factors to this process, however the exact pathogenesis has not been fully elucidated. The current gold standard in melasma treatment is lightening cream containing hydroquinone (HQ). Tretinoin can be added to increase efficacy, and the combination of both agents plus a topical corticosteroid is the most effective regimen currently available. Overuse can lead to fixed erythema and telangiectasias, acneiform eruptions and hypertrichosis. Other treatment options with minimal to moderate efficacy include methimazole, azelaic acid, kojic acid, vitamin C, and arbutin. Some studies indicate that mequinol (4-hydroxyanisole; 4-HA) 2% may actually be a more effective depigmentation agent than hydroquinone 3%, and it’s use in combination with tretinoin 0.01% has shown efficacy in treating solar lentigines, with decreased incidence of skin irritation in swine models, but there is currently insufficient evidence to support this finding in human subjects. Various procedures such as peels and laser or light-based treatments have been proposed as effective treatments, but with mixed results in published clinical studies. These treatments also carry a risk of skin irritation and either hyper- or hypopigmentation or even scarring. We present a case of melasma that demonstrated marked improvement after a course of systemic isotretinoin targeting acne.
Keywords: Melasma; Isotretinoin treatment
