Syneron candela laser use hydraquinone12/6/2023 The epidermal form is easier to treat and more amenable to topical therapy, while dermal or mixed melasma is more resistant to treatment.” Strict Photoprotectionįirst-line treatments involve sun protection and some combination of topical skin lighteners and chemical or mechanical peels. In dermal melasma, which appears more blue-gray, melanin is found in the superficial and deep perivascular melanosomes, and the pigment does not enhance with Wood’s lamp illumination. “Historically a Wood’s lamp examination is used to enhance these lesions to aid in distinguishing epidermal from dermal melasma. “In the epidermal form, characterized by brown color, melanin is found in the basal and suprabasal layers,” says Mona Sadeghpour, MD, currently pursuing a fellowship with Jeffrey Dover, MD, and his colleagues at Skincare Physicians, Chestnut Hill, Massachusetts. I often use dermoscopy to look for patterns that can indicate a more superficial, rather than deep, disease.”ĭetermining the type of melasma and depth of excess melanin deposits is important in providing the most effective treatments and advising a patient on the most likely prognosis. “Determining the depth of pigment deposits can be very difficult. “We refer to melasma as an epidermal or dermal disease however, the majority of cases involve pigment in all skin layers,” says Dr. While dermatologists currently employ a wide array of treatments ranging from sunscreens and daily topical lighteners to controlled skin peels and laser or light-based procedures, reliable, consistent, long-term clearance of melasma remains among their most difficult challenges. Vashi, MD, assistant professor of dermatology at the Boston University School of Medicine and director of the Boston University Center for Ethnic Skin. “The three typical patterns are centrofacial, involving the cheeks, forehead, upper lip, nose and chin malar, involving the cheeks and nose and mandibular, involving the lower sides of the face,” says Neelam A. Rendon, MD, Rendon Center, Boca Raton, Florida. “Melasma can be categorized according to clinical patterns and histopathology, or depth of pigment in the skin,” says dermatologist Marta I. Causes include a complex amalgam of genetic and hormonal influences that are not yet fully understood, and treatment is challenging. Sometimes called the “mask of pregnancy,” melasma is more common among women but is also seen in men. Dermatologists see it regularly-symmetrical patches of excess pigmentation across the nose and/or on the cheeks, chin and forehead.
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