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What Is Melasma?
1–3
Symmetric Hyperpigmentation Darkened patches of skin usually occurring symmetrically on both sides of the face
Appearance Irregular light-to-dark brown macules. Macules are uneven spots or patches of discolouration
Location Centrofacial Mandibular Malar
Mainly on photo-exposed areas of the face, such as Cheeks Upper lips Forehead
Symptoms Melasma is asymptomatic. It does not cause any physical discomfort or symptoms other than the visible pigmentation
Classification of Melasma
2
Melasma can be characterised by the depth of melanin deposition in the skin layers and divided into three histological types
Epidermal
Dermal
Mixed
Increased melanin throughout the layers of the epidermis
Increased melanin throughout the epidermis and the superficial and deep dermis
Combined histologic features of epidermal and dermal types
Prevalence of Melasma
3–11
High Prevalence in Asia More common in some populations than others, including
East and Southeast Asians Chinese, Indonesian, Japanese, Korean, Thai
Statistics 2 in 5 present with melasma Between 4.7–18% prevalence in Chinese females
Age of Onset Varies from
20–40 years old
Who Is At Risk?
1,3,5,9,10,12
Melasma development is attributed to multiple factors
Genetic Predisposition More common in
females
Beige and light to dark brown skin types (Fitzpatrick skin types III to V)
Family history Around half of the melasma patients report a positive family history
Hormonal Factors Pregnancy
Postmenopausal women
Thyroid disease
Stress
Environmental Factors Sunlight exposure
Medication
Impact on Quality of Life
13–15
Reduced Confidence and Self-esteem Melasma can significantly lower a person’s confidence and self-esteem due to visible skin changes
Mental Health Impact
Anxiety
Depression
The appearance of melasma can lead to increased anxiety
Persistent melasma may contribute to feelings of depression
References: 1. Ogbechie-Godec OA & Elbuluk N. Dermatol Ther (Heidelb). 2017;7(3):305–18. 2. Honigman A & Rodrigues M. Dermatol Rev. 2023;4(1):30–7. 3. Doolan BJ & Gupta M. Aust J Gen Pract. 2021;50(12):880–5. 4. Khoza N, et al. (2015) Epidemiology and Global Distribution of Melasma. In Sarkar R (Ed) Melasma: A Monograph (pp 1–3). Jaypee Brithers Medical Publishers. 5. Goh CL, et al. Photodermatol Photoimmunol Photomed. 2024;40(1):e12932. 6. Esposito ACC, et al. Dermatol Ther (Heidelb). 2022;12(9):1967–88. 7. Taylor SC. Dermatol Clinic. 2003;21(4):601–7. 8. Wu MX, et al. Cureus. 2021;13(4):e14398. 9. Majid I & Aleem S. J Skin Stem Cell. 2021;8(4):e120283. 10. Handel AC, et al. An Bras Dermatol. 2014;89(5):771–82. 11. Chen Z, et al. Trials. 2015;16:156. 12. American Academy of Dermatology Association. Available online. https://www.aad.org/public/diseases/a-z/melasma-causes. Last accessed: 3 July 2024. 13. Jiang J, et al. Int J Womens Dermatol. 2018;4(1):38–42. 14. Chen W, et al. Front Psychiatry. 2024;14:1276906. 15. Platsidaki E, et al. Dermatol Ther (Heidelb). 2023;13(5):1127–36.