Sofía Laguna Rocafort
Jeevan Rivera-Díaz
Ingrid Bonilla Mercado, PhD
José Rabelo Cartagena, MD

VA Caribbean Healthcare System, San Juan, Puerto Rico
Universidad Central del Caribe, Bayamón, Puerto Rico

Introduction

Melasma is a common, chronic, acquired hyperpigmentation disorder that predominantly affects women, with a prevalence of 0.18% in the United States as of 2023. Despite its widespread impact, the exact pathophysiology remains unclear, as melasma is considered a multifactorial disease influenced by solar elastosis, photoaging, hormonal interplay, altered basement membranes, dermal inflammation, and increased production of melanin, mast cells, and stem cell factors. The study aims to summarize the latest pathological contributors and pharmacological, non-pharmacological, and emerging investigational treatments to enhance understanding and management of melasma.

Methods

This narrative review was conducted using the Scale for the Assessment of Narrative Review Articles (SANRA) to ensure methodological rigor and a comprehensive search strategy. It examines the pathological contributors and various therapeutic approaches, including medical, procedural, and investigational treatments for melasma. Diagnosis methods, such as normal light examination, Wood’s lamp, and dermoscopy, were also reviewed.

Results

The review highlights the significance of photoprotection and presents a range of treatment options, including topical and systemic medications, microneedling, chemical peels, lasers, and platelet-rich plasma. Emerging investigational treatments are discussed, demonstrating advancements in understanding and managing the condition.

Conclusion

Current findings indicate significant progress in understanding melasma’s pathophysiology and therapeutic strategies. However, further research is necessary to develop more effective interventions that improve patient outcomes and quality of life.