(What is Melasma (賀爾蒙斑)?) Photo by Elord from Wikidocs, See commons.wikimedia.org

Melasma is a common skin pigmentation disorder characterized by uneven dark or light patches primarily appearing on the face, especially on the cheeks, forehead, eyelids, nose, lips, and chin. These patches result from overactive melanocytes producing excessive melanin in localized areas. Although melasma is a benign condition and typically does not cause physical discomfort, its noticeable appearance often negatively impacts patients’ aesthetics and psychological confidence.

Approximately 90% of melasma patients are women, with a higher incidence during periods of significant hormonal changes, such as pregnancy, postpartum, or while taking oral contraceptives. Additionally, hormonal imbalances, thyroid dysfunction, and genetic predisposition are considered key factors contributing to melasma. Beyond endocrine factors, prolonged ultraviolet (UV) exposure, environmental pollution, and stress can exacerbate skin pigmentation, worsening the condition.

From a pathogenesis perspective, melasma involves a complex interplay of multiple internal and external factors. Hormonal fluctuations, particularly in estrogen and progesterone levels, often stimulate melanocyte proliferation, leading to localized skin darkening. UV exposure directly promotes melanin synthesis and damages the skin barrier, making pigment deposition more pronounced. Phototoxic drugs, antiepileptic medications, and certain other drugs may also trigger or aggravate melasma. The pathological process is a dynamic interaction of multiple factors, underscoring the need for comprehensive management in treatment.

For the treatment of melasma, commonly used clinical approaches include topical medications, chemical peels, and laser therapy. Among topical agents, '氫醌' (Hydroquinone) is a widely used skin-lightening ingredient that inhibits melanin production, while topical '維甲酸' (Retinoid) promotes cell turnover and keratin renewal, improving skin texture. In some cases, doctors may prescribe a “three-in-one ointment,” a combination of '氫醌' (Hydroquinone), '維甲酸' (Retinoid), and '類固醇' (Steroid), to enhance the lightening effect. Chemical peels can accelerate epidermal turnover to improve pigmentation, while laser therapy uses precise energy to break down excess melanocytes and stimulate collagen regeneration, helping to fade spots. However, both chemical peels and laser treatments carry a risk of skin irritation or worsening of melasma if not performed properly, so these procedures must be conducted under the guidance of an experienced physician.

Beyond treatment, prevention plays a critical role in managing melasma. Avoiding prolonged direct sun exposure, using appropriate sunscreen products, and wearing protective clothing are effective measures to reduce UV-induced pigmentation. Patients should also avoid medications that may cause phototoxicity and actively manage stress and environmental factors, which contribute to preventing further aggravation of pigmentation. For existing patches, alongside active treatment, daily skincare, dietary adjustments, and moderate exercise can support skin metabolism, aiding in prevention and complementary treatment.

In summary, melasma is a skin pigmentation disorder driven by hormonal changes, UV exposure, and various other factors, predominantly affecting women, especially during pregnancy or postpartum. Treatment options, including topical '氫醌' (Hydroquinone), '維甲酸' (Retinoid), combination ointments, chemical peels, and laser therapy, each have their advantages and limitations, requiring personalized plans based on the patient’s condition and skin type. Prevention focuses on avoiding sun exposure, maintaining healthy lifestyle habits, and regular skin checkups. Consulting an experienced physician can effectively manage and improve melasma, helping patients regain a radiant, even complexion.

References:
1. Grimes, D. A., et al. (2011). "Melasma: A Clinical Review." Obstetrics and Gynecology Clinics of North America, 38(3), 385-395.
2. Sarkar, R., et al. (2017). "Melasma: A Review of Pathogenesis, Etiology, Clinical Features, and Treatment Options." Clinical, Cosmetic and Investigational Dermatology, 10, 129-136.
3. Pandya, A. G., et al. (2010). "Management of melasma: a comprehensive review." Journal of Cutaneous and Aesthetic Surgery, 3(1), 11-20.