Melasma management

Melasma is a common chronic acquired disorder of symmetric hyperpigmented patches on the face, more common in women (pregnancy, hormonal contraception and sun exposure worsen it).

Clinical presentation

• Bilateral, symmetrical brown macules or patches with irregular borders on the forehead, nose, cheeks, upper lip and chin.

Non-pharmacological management

• Sun protection with a wide-brimmed hat; camouflage make-up if desired.

• Avoid unsupervised bleaching creams (steroids, mercury, hydroquinone misuse).

Pharmacological management

• S: Tretinoin cream once daily at night for 3–6 months,

• AND B: sunscreen SPF 30 or higher applied at least twice a day (morning and noon).

• Alternatives (specialist): chemical peels or laser therapy.