Melasma Management: How I Do It
Abstract
Melasma is a common acquired disorder of hyperpigmentation which has a strong predilection for females and is more common in individuals with Fitzpatrick skin phototypes III-VI. It is most common on the face but can occur on the neck, upper chest, extensor forearms and upper back.
The pathogenesis of melasma is both multifactorial and incompletely understood. There is an increase in epidermal and dermal melanin without a similar increase in the number of melanocytes. Melanocytes are enlarged with elongated dendrites and increased numbers of melanosomes. An increase in mast cells, dermal blood vessels, abnormalities of the basement membrane and solar elastosis can also be seen. The number of blood vessels, vessel size and density are all increased in lesional melasma skin. Increasing evidence is emerging that points to melasma as a disorder of photoaging in genetically predisposed individuals.
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