Patient expectations are commonly not met by available treatments. Results take time and the available measures are rarely completely successful.
Epidermal (superficial) melasma usually has a dark brown colour, a well defined border and responds well to treatment
Dermal (deep) melasma has an ill-defined border and a light brown/bluish colour and responds poorly to treatment
Mixed melasma is a mixture of the two and is the most common type. Partial improvement with treatment is common.
Treatment is more effective if the pigmentation is superficial rather than deep. It is advisable to change oral contraceptive to alternative methods.
A combination of treatments are used in conjunction with good sun protection
- Deep chemical peels
- Tyrosinase inhibitors and melanocyte sedators
Unfortunately, even in those that get a good result from treatment, pigmentation may reappear on exposure to summer sun and/or because of hormonal factors.
New topical and oral agents are being studied and offer hope for effective treatments in the future.