Unmasking Melasma: Confronting the Treatment Challenges

Melasma, also known as chloasma and the “mask of pregnancy”, is a common acquired pigmentary disorder characterized by irregular, hyperpigmented brown-to-grey patches primarily situated on the face. It typically affects women of reproductive age, especially those exhibiting Fitzpatrick skin types III to V. The precise etiopathogenesis of melasma is complex and has not been fully elucidated; however, ultraviolet radiation, hormonal factors, and genetic predispositions significantly contribute to the melanin production increase associated with this condition. Due to the multifactorial aetiology, resistance to various therapeutic options, and high recurrence rate, treating melasma is challenging. Hydroquinone has long been considered a gold standard in melasma treatment due to its ability to inhibit tyrosinase; however, it has faced scrutiny after concerns about its adverse effects. Current treatment strategies include various topical and systemic therapies, procedural interventions, as well as combinations of these methods. For optimal results, both photoprotection and a treatment plan that targets different pathogenic mechanisms should be used. Additionally, treatment should be tailored to patient characteristics, such as skin type, the severity of the condition, and compliance. This review summarises current treatment options, focusing on long-term therapy and the latest advancements in managing this challenging condition.