Historically, melasma has been a difficult-to-treat condition, confounded by hard-to-avoid sun exposure and characterized by flare rebounds. Recent research, though, is shedding light on how the hyperpigmentation occurs, clueing dermatologists into potential new treatment avenues.
Having a better understanding of what might cause the condition and being able to recognize it can help providers give patients the highest level of care possible, meeting their physical and mental needs.
“We know melasma is a therapeutically challenging condition because when you cease to treat it — or even during treatment — there can almost be a universal relapse with the current tools we have in our toolbox,” says Pearl Grimes, M.D., director of the Vitiligo and Pigmentation Institute of Southern California. “Ideally, we’d love to find something we can use to clear up the patient and get them in a sustained state of remission, but we’re not there yet.”
Still, she says, new data surrounding melasma is launching dermatology in the right direction.
THE PATHOGENESIS OF MELASMA
Sunlight is known to be a major player in melasma with ultraviolet light being a significant trigger, she says. But, new data also points to a role for visible light, particularly low-spectrum blue light. By activating the exon 3 pathway on melanocytes, visible light triggers the dopachrome complex responsible for the sustained hyperpigmentation of melasma.
But, there’s more at play than sunlight exposure, says Seemal Desai, M.D., president of the Skin of Color Society.
1. Roberts WE. Pollution as a risk factor for the development of melasma and other skin disorders of facial hyperpigmentation - is there a case to be made?. J Drugs Dermatol. 2015;14(4):337-41.