Melasma is undoubtedly a ubiquitous condition presenting to many dermatologists. While the clinical diagnosis appears relatively unchallenging, satisfactory cure often evades patients and their practitioners. Let’s look at the image in Figure 1. Most readers will have little difficulty in making this diagnosis and proposing a treatment plan. It could be considered insouciant to approach this as simple ‘excess pigmentation’. In the last few years significant advances have been made in the understanding of melasma and its pathophysiology, which we endeavour to summarise in this article.
Let’s start from the upper part of the skin – the epidermis. In addition to the melanocytes which produce melanin through melanogenesis, there are keratinocytes and important receptors which play a role in the process of melasma.1
Keratinocytes produce a multiplicity of factors implicated in melasma, including vascular endothelial growth factors (VEGF), melanocyte stimulating hormone (MSH), and inducible nitric oxide synthase…
