Review of modern melasma treatment methods

Melasma is a common, difficult-to-treat pigmented skin disease characterized by a recurrent course. The article provides an overview of the etiology, pathogenesis and principles of melasma therapy. The multifactorial nature of the disease was noted, including genetic predisposition, exposure to ultraviolet and visible light, and hormonal factors. It is known that visible light, especially high-energy visible light with a wavelength of 400–500 nm (High Energy Visible Light, HEV rays, blue light), and long-wavelength UVA rays (370–400 nm) exacerbate the course of melasma. The importance of an integrated approach to treatment, including the elimination of trigger factors, pathogenetic therapy and mandatory photoprotection using modern broad-spectrum sunscreens, is emphasized. Special attention is paid to the need to inform patients about the chronic nature of melasma and the importance of prolonged therapy. The article considers a multi-level treatment regimen based on the use of topical drugs and peels as first-line therapy, with careful and balanced use of hardware methods at subsequent stages. The key principles of hyperpigmentation therapy are described, namely, inhibition of melanogenesis, reduction of melanosome transport and acceleration of melanin elimination processes. Given example of modern depigmenting topical treatment containing Thiamidol (Beiersdorf AG patent), which contribute to the improvement of mMASI (Modified Melasma Area and Severity Index) after 2 weeks of usage, and justified treatment with Thiamidol for monoand combination therapy of melasma. The proposed three-stage treatment regimen, adapted to the severity of the disease, makes it possible to optimize therapeutic tactics taking into account the individual characteristics of the patient.