Comprehensive Evaluation of Pathogenesis, Risk Factors and Current Therapeutic Strategies in Melasma: A Clinical and Molecular Perspective
Main Article Content
Abstract
Melasma, an acquired facial hyperpigmentation of a chronic nature, presents a clinical and dermatologic enigma of considerable relevance. This article focuses on a comprehensive review of the underlying pathogenesis of melasma from a molecular and clinical perspective, exploring its multifactorial etiology and the triggering elements that converge in the cascade of biochemical and cellular events that result in its distinctive clinical manifestation. Known risk factors such as excessive sun exposure, hormonal imbalances and genetic predisposition are thoroughly discussed, unraveling their relative contribution and complex interplay in the development of melasma.
In addition, a critical analysis is made of current therapeutic strategies, ranging from conventional topical approaches to more advanced modalities such as laser therapy and technology-based treatments. The efficacy, safety and limitations of these modalities are examined, considering variations in patient response and the durability of the results obtained.
Ultimately, this article seeks to provide a comprehensive synthesis of contemporary advances in the understanding and management of melasma, with the aspiration of guiding dermatologic health care professionals toward more accurate and individualized approaches in the diagnosis and treatment of this complex skin condition.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Arellano-Mendoza I, Arias-Gómez I, Barba-Gómez JF et al., Melasma: Consensus of the Mexican Group for the Study of Pigmentary Disorders, dcmq 2007; 5(2):112-22.
II. Ai-Young L, Recent progress in melasma pathogenesis, Pigment Cell Melanoma Res 2015; 28(6):648-60.
III. Adalatkhah H, Sadeghi-Bazargani H, Amini-Sani N and Zeynizadeh S, Melasma and its association with different types of nevi in women, bmc Dermatology 2008; 8(3):1-5.
IV. Alcalá Pérez D, Espinosa Villaseñor N and Jurado Santa Cruz F, Melasma in men, Rev Cent Dermatol Pascua 2015; 24(1):14-20.
V. Ritter CG, Fiss DV, Borges da Costa JA et al, Extra-facial melasma: clinical, histopathological, and immunohistochemical case-control study, J Eur Acad Dermatol Venereol 2013; 27(9):1088-94, doi: 10.1111/j.14683083.2012.04655. Epub, July 24, 2012.
VI. Mercadillo Pérez P and Moreno López LM, Physiopathology of melasma, dcmq 2010; 8(3):481-5.
VII. Handel AC, Miot LD and Miot HA, Melasma: a clinical and epidemiological review, Ann Bras Dermatol 2014; 89(5):771-82.
VIII. Ortonne JP, A global survey of the role of uv radiation and hormonal influences in the development of melasma, J Eur Eur Acad Dermatol Venerol 2009; 23(11):1254-62.
IX. Tamega AA and Miot LDB, Clinical patterns and epidemiological characteristics of facial melasma in Brazilia Women, J Eur Eur Acad Dermatol Venereol 2013; 27(2):151-6, doi:
X. 1111/j.1468-3083.2011.04430.x. Epub, January 3, 2012. 10. Lee, A.Y., "An updated review of melasma pathogenesis," Dermatologica Sinica, 2014, 233-9.
XI. Kang HY, Suzuki I, Lee DJ et al, Transcriptional profiling shows altered expression of wnt pathway and lipid metabolism-related genes as well as melanogenesis-related genes in melasma, J Invest Dermatol 2011; 13(8):1692-700.
XII. Hernández-Barrera R, Torres-Álvarez B, Castanedo-Cázares JP et al., Solar elastosis and presence of mast cells as key features in the pathogenesis of melasma, Clin Exp Dermatol 2008; 33(3):305-8.
XIII. Kang HY, Hwang JS, Lee JY et al, The dermal stem cell factor and c-kit are overexpressed in melasma, Br J Dermatol 2006; 154(6): 1094-9.
XIV. Torres-Alvarez B, Mesa-Garza IG, Castanedo-Cázares JP et al, Histochemical and immunohistochemical study in melasma: evidence of damage in the basement membrane, Am J Dermatopathol 2011; 33:291-5.
XV. Famenini S and Gharavi NM, Finasteride associated melasma in a Caucasian male, J Drugs Dermatol 2014; 13(4):484-6.
XVI. Kippenberger S, Loitsch S, Solano F, Bernd A and Kaufmann R, Quantification of tyrosinase, trp-1, and trp-2 transcripts in human melanocytes by reverse transcriptase-competitive multiplex pcr-regulation by steroid hormones, J Invest Dermatol 1998; 110(4):364-7.
XVII. Jang YH, Lee JY, Kang HY, Lee ES and Kim YC, Oestrogen and progesterone receptor expression in melasma: an immunohistochemical analysis, J Eur Acad Dermatol Venereol 2010; 24(11):1312-6, doi: 10.1111/ j.1468-3083.2010.03638.
XVIII. Pérez M, Sánchez JL and Aguiló F, Endocrinologic profile of patients with idiopathic melasma, J Invest Dermatol 1983; 81(6):543-5.