Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

4 Issues per year

Open Access
See all formats and pricing
More options …

New Aspects of Melasma/Novi aspekti melazme

Katerina Damevska
  • Corresponding author
  • University Clinic of Dermatology, Medical faculty, Ss Cyril and Methodius University, Skopje, Macedonia
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-07-26 | DOI: https://doi.org/10.2478/sjdv-2014-0001


Melasma is a common cosmetic problem and its severity ranges from minor pigmentation during pregnancy that resolves spontaneously, to a chronic, troublesome, disfiguring condition. Today, there are various treatment modalities for melasma, providing a different success rate. The need for an effective treatment for melasma is becoming more and more significant probably due to the current lifestyles with increased UV exposure, broad use of hormones for contraception and hormone replacement therapy, as well as increasing esthetic demands. The mainstay of treatment is regular use of sunscreens along with topical medications suppressing melanogenesis. This review summarizes recent progress in understanding the pathophysiology of melasma and implications for new treatment strategies.

Keywords: Melanosis; Dermatologic Agents; Hydroquinones; Sunscreening Agents; Skin Lightening Preparations; Laser Therapy; Diagnosis; Differential

Ključne reči: Melanoza; Dermatološki preparati; Hidrokvinon; Fotozaštitni preparati; Preparati za posvetljivanje kože; Laserska terapija; Diferencijalna dijagnoza


  • 1. Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol. 2013 Oct;14(5):359-76.CrossrefGoogle Scholar

  • 2. Ho SG, Chan HH. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol. 2009;10(3):153-68.CrossrefGoogle Scholar

  • 3. Tamega Ade A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013; 27(2):151-6.CrossrefGoogle Scholar

  • 4. Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA, Kalil CL, Ayres EL, et al. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol. 2014;53(4):440-4.CrossrefGoogle Scholar

  • 5. Wu IB, Lambert C, Lotti TM, Hercogova J, Sintim-Damoa A, Schwartz RA. Melasma. G Ital Dermatol Venereol. 2012 Aug;147(4):413-8.Google Scholar

  • 6. Kim NH, Lee CH, Lee AY. H19 RNA downregulation stimulated melanogenesis in melasma. Pigment Cell Melanoma Res. 2010 Feb;23(1):84-92.CrossrefGoogle Scholar

  • 7. Perez-Bernal A, Munoz-Perez MA, Camacho F. Management of facial hyperpigmentation. Am J Clin Dermatol. 2000;1(5):261-8CrossrefGoogle Scholar

  • 8. Kim NH, Cheong KA, Lee TR, Lee AY. PDZK1 upregulation in estrogen-related hyperpigmentation in melasma. J Invest Dermatol. 2012 Nov;132(11):2622-31.CrossrefGoogle Scholar

  • 9. Lieberman R, Moy L. Estrogen receptor expression in melasma: results from facial skin of affected patients. J Drugs Dermatol. 2008 May;7(5):463-5.Google Scholar

  • 10. Perez M, Sanchez JL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol. 1983;81(6):543-5.CrossrefGoogle Scholar

  • 11. Sawhney M, Anand R. Chronic pelvic inflammatory disease and melasma in women. Indian J Dermatol Venereol Leprol. 2003;69(3):251-2.Google Scholar

  • 12. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009 Nov;23(11):1254-62.CrossrefGoogle Scholar

  • 13. Bak H, Lee HJ, Chang SE, Choi JH, Kim MN, Kim BJ. Increased expression of nerve growth factor receptor and neural endopeptidase in the lesional skin of melasma. Dermatol Surg. 2009 Aug;35(8):1244-50.CrossrefGoogle Scholar

  • 14. Kim EJ, Park HY, Yaar M, Gilchrest BA. Modulation of vascular endothelial growth factor receptors in melanocytes. Exp Dermatol. 2005;14(8):625-33.CrossrefGoogle Scholar

  • 15. Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46(2):111-6.CrossrefGoogle Scholar

  • 16. Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, Kim My, et al. Localized intradermal microinjection of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Dermatol Surg. 2006;32(5):626-33.CrossrefGoogle Scholar

  • 17. Grimes PE, Yamada N, Bhawan J. Light microscopic, immunohistochemical, and ultrastructural alterations in patients with melasma. Am J Dermatopathol. 2005;27(2):96-101.CrossrefGoogle Scholar

  • 18. Katsambas A, Antoniou C. Melasma: classification and treatment. J Eur Acad Dermatol Venereol. 1995;4(3):217-23.CrossrefGoogle Scholar

  • 19. Gupta LK, Singhi MK. Wood’s lamp. Indian J Dermatol Venereol Leprol. 2004;70(2):131-5 .Google Scholar

  • 20. Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm Mc Jr. Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol. 1981:4(6):698-710.CrossrefGoogle Scholar

  • 21. Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011 Oct;65(4):689-97.CrossrefGoogle Scholar

  • 22. Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN, et al . Topical retinoic acid (tretinoin) for melasma in black patients. A vehicle-controlled clinical trial. Arch Dermatol. 1994;130(6):727-33.CrossrefGoogle Scholar

  • 23. Pawaskar MD, Parikh P, Markowski T, McMichael AJ, Feldman SR, Balkrishnan R. Melasma and its impact on health-related quality of life in Hispanic women. J Dermatolog Treat. 2007;18(1):5-9.CrossrefGoogle Scholar

  • 24. Cestari TF, Hexsel D, Viegas ML, Azulay L, Hassun K, Almeida Ar, et al. Validation of a melasma quality of life questionnaire for Brazilian Portuguese language: the MelasQoL-BP study and improvement of QoL of melasma patients after triple combination therapy. Br J Dermatol. 2006 Dec;156 Suppl 1:13-20.Google Scholar

  • 25. Prignano F, Ortonne JP, Buggiani G, Lotti T. Therapeutical approaches in melasma. Dermatol Clin. 2007 Jul;25(3):337-42.CrossrefGoogle Scholar

  • 26. Smit N, Vicanova J, Pavel S. The hunt for natural skin whitening agents. Int J Mol Sci. 2009 Dec 10;10(12):5326-49. CrossrefGoogle Scholar

  • 27. Katsambas AD, Stratigos AJ. Depigmenting and bleaching agents: coping with hyperpigmentation. Clin Dermatol. 2001 Jul-Aug;19(4):483-8.CrossrefGoogle Scholar

  • 28. Solano F, Briganti S, Picardo M, Ghanem G. Hypopigmenting agents: an updated review on biological, chemical and clinical aspects. Pigment Cell Res. 2006 Dec;19(6):550-71.CrossrefGoogle Scholar

  • 29. Twenty-fourth directive 2000/6/EG Publication nr L 056, European Union; 2000.Google Scholar

  • 30. Westerhof W, Kooyers TJ. Hydroquinone and its analogues in dermatology - a potential health risk. J Cosmet Dermatol. 2005 Jun;4(2):55-9.CrossrefGoogle Scholar

  • 31. Enguita FJ, Leitao AL. Hydroquinone: environmental pollution, toxicity, and microbial answers. Biomed Res Int. 2013;2013:542168.Google Scholar

  • 32. Gillner M, Moore GS, Cederberg H. International Programme on Chemical Safety Panel of Experts. Environmental Health Criteria 157: Hydroquinone. Available from: http://www. inchem.org/documents/ehc/ehc/ehc157.htmGoogle Scholar

  • 33. U.S. Food & Drug Administration, Department of Health and Human Services. Nomination Profile: Hydroquinone [CAS 123-31-9]. Supporting Information for Toxicological Evaluation by the National Toxicology Program 21 May 2009. Available from: http://ntp.niehs.nih.gov/ntp/noms/support_ docs/hydroquinone_may2009.pdfGoogle Scholar

  • 34. Katsambas AD, Stratigos AJ, Lotti TM. Melasma. In: Katsambas AD, Lotti TM, editors. European handbook of dermatological treatments. 2nd ed. Berlin: Springer; 2003. p. 336-41.Google Scholar

  • 35. Farshi S. Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma. J Cosmet Dermatol. 2011 Dec;10(4):282-7.CrossrefGoogle Scholar

  • 36. Monteiro RC, Kishore BN, Bhat RM, Sukumar D, Martis J, Ganesh HK. A Comparative study of the efficacy of 4% hydroquinone vs 0.75% Kojic acid cream in the treatment of facial melasma. Indian J Dermatol. 2013 Mar;58(2):157.CrossrefGoogle Scholar

  • 37. Deo KS, Dash KN, Sharma YK, Virmani NC, Oberai C. Kojic acid vis-a-vis its combinations with hydroquinone and betamethasone valerate in melasma: a randomized, single blind, comparative study of efficacy and safety. Indian J Dermatol. 2013 Jul;58(4):281-5.CrossrefGoogle Scholar

  • 38. Taylor MB, Yanaki JS, Draper DO, Shurtz JC, Coglianese M. Successful short-term and long-term treatment of melasma and postinflammatory hyperpigmentation using vitamin C with a full-face iontophoresis mask and a mandelic/malic acid skin care regimen. J Drugs Dermatol. 2013 Jan;12(1):45-50.Google Scholar

  • 39. Ortonne JP. Retinoid therapy of pigmentary disorders. Dermatol Ther. 2006 Sep-Oct;19(5):280-8CrossrefGoogle Scholar

  • 40. Gold M, Rendon M, Dibernardo B, Bruce S, Lucas-Anthony C, Watson J. Open-label treatment of moderate or marked melasma with a 4% hydroquinone skin care system plus 0.05% tretinoin cream. J Clin Aesthet Dermatol. 2013 Nov;6(11):32-8.Google Scholar

  • 41. Dogra S, Kanwar AJ, Parsad D. Adapalene in the treatment of melasma: a preliminary report. J Dermatol. 2002 Aug;29(8):539-40.CrossrefGoogle Scholar

  • 42. Faghihi G, Shahingohar A, Siadat AH. Comparison between 1% tretinoin peeling versus 70% glycolic acid peeling in the treatment of female patients with melasma. J Drugs Dermatol. 2011 Dec;10(12):1439-42.Google Scholar

  • 43. Brazzini B, Hautmann G, Ghersetich I, Hercogova J, Lotti T. Laser tissue interaction in epidermal pigmented lesions. J Eur Acad Dermatol Venereol. 2001 Sep;15(5):388-91.CrossrefGoogle Scholar

  • 44. Lee DB, Suh HS, Choi YS. A comparative study of lowfluence 1064-nm Q-switched Nd:YAG laser with or without chemical peeling using Jessner’s solution in melasma patients. J Dermatolog Treat. 2014 Dec;25(6):523-8.CrossrefGoogle Scholar

  • 45. Lee HI, Lim YY, Kim BJ, Kim MN, Min HJ, Hwang JH, et al. Clinicopathologic efficacy of copper bromide plus/yellow laser (578 nm with 511 nm) for treatment of melasma in Asian patients. Dermatol Surg. 2010 Jun;36(6):885-93.CrossrefGoogle Scholar

  • 46. Zaleski L, Fabi S, Goldman MP. Treatment of melasma and the use of intense pulsed light: a review. J Drugs Dermatol. 2012 Nov;11(11):1316-20.Google Scholar

  • 47. Figueiredo Souza L, Trancoso Souza S. Single-session intense pulsed light combined with stable fixed-dose triple combination topical therapy for the treatment of refractory melasma. Dermatol Ther. 2012 Sep-Oct;25(5):477-80.CrossrefGoogle Scholar

  • 48. Chung JY, Choi M, Lee JH, Cho S, Lee JH. Pulse in pulse intense pulsed light for melasma treatment: a pilot study. Dermatol Surg. 2014 Feb;40(2):162-8.CrossrefGoogle Scholar

  • 49. Rendon M, Berneburg M, Arellano I, Picardo M. Treatment of melasma. J Am Acad Dermatol. 2006 May;54(5 Suppl 2):S272-81.CrossrefGoogle Scholar

  • 50. Draelos ZD. Skin lightening preparations and the hydroquinone controversy. Dermatol Ther. 2007 Sep-Oct;20(5):308-13.CrossrefGoogle Scholar

  • 51. Yousefi A, Khani Khoozani Z, Zakerzadeh Forooshani S, Omrani N, Moini AM, Eskandari Y. Is topical zinc effective in the treatment of melasma? A double-blind randomized comparative study. Dermatol Surg. 2014 Jan;40(1):33-7.CrossrefGoogle Scholar

  • 52. Zhu W, Gao J. The use of botanical extracts as topical skinlightening agents for the improvement of skin pigmentation disorders. J Investig Dermatol Symp Proc. 2008 Apr;13(1):20-4. Google Scholar

About the article

Published Online: 2014-07-26

Published in Print: 2014-03-01

Citation Information: Serbian Journal of Dermatology and Venereology, Volume 6, Issue 1, Pages 5–18, ISSN (Online) 2406-0631, ISSN (Print) 1821-0902, DOI: https://doi.org/10.2478/sjdv-2014-0001.

Export Citation

© 2014. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

Comments (0)

Please log in or register to comment.
Log in