Mélasma : prise en charge globale

To date, the pathogenesis of melasma is still unclear and consequently, treatment is frequently disappointing, both for the physician and the patient. Treatment of melasma is difficult and should not be exclusively limited to the formulation of skin lightening preparation. A rapid decrease of pigmentation and clearance of melasma macules may be obtained if some treatment guidelines are taken into account. Examination of the skin with both visible and Wood’s light, and sometimes biopsy are necessary to determine the pattern of the hyperpigmentation. Patients are questioned on the time of melasma onset, relationship of melasma to triggering factors (pregnancy, or oestrogen progesterone ingestion), and to exacerbating factors such as mechanical traumas and sunlight. Finally, an effective skin lightening treatment can be proposed for the epidermal pattern of melasma. However, effective treatment of dermal melasma do not exist currently, except camouflage.