Topical Treatments for Melasma and Postinflammatory Hyperpigmentation

C.B. Lynde; J.N. Kraft, MD; C.W. Lynde, MD, FRCPC


Skin Therapy Letter. 2006;11(9):1-6. 

In This Article


Melasma is a common acquired pigmentary disorder that occurs mainly in women (more than 90% of cases)[6] of all racial and ethnic groups, but particularly affects those with Fitzpatrick skin types IV-VI.[7] While the cause of melasma is unknown, factors include: a genetic predisposition, ultraviolet light exposure, and estrogen exposure.[8] Estrogen is thought to induce melasma as it often develops during pregnancy, with use of oral contraceptives, and with hormone replacement therapy (HRT) in postmenopausal women.[9] Melasma in pregnancy usually clears within a few months of delivery.

Discontinuation of oral contraceptives or HRT, in combination with adequate sun protection, may also result in melasma clearance,[10] although there is a paucity of literature with regard to HRT and the clearance of this condition.

Melasma presents as brown to grey macules and patches, with serrated, irregular, and geographic borders.[7] The pigmented patches are usually sharply demarcated[10] and symmetrical. Melasma has a predilection for sun-exposed areas. The three major patterns of distribution are: centrofacial (cheeks, forehead, upper lip, nose, and chin) (66% of cases), malar (cheeks and nose) (20% of cases) and mandibular (rami of the mandible) (15% of cases). See Table 1 for the differential diagnosis.[8]


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