Melasma is a disorder of the facial skin pigmentation, often, especially in women, and related to sun exposure and hormonal factors in a person genetically predisposed to the appearance of stains. Melasma is not always associated with pregnancy or oral contraceptive use, but may be important factors in their development. There are patients who complain of the appearance of stains on the face only after their second or third pregnancy, indicating that age must also play an important role in the appearance of pigmentation melasma facial type, determining the start and intensity modulated them.

The main trigger for the appearance of melasma is exposure to ultraviolet light, which increases the synthesis of the hormone alpha-MSH and ACTH, which leads both to the proliferation of melanocytes and the increased synthesis of melanin (pigment brown color to the skin).

It has recently been seen in melasma, there is an increase in the vascularization of the skin lesions clinically and histologically. This might be related to an increase in the expression of angiogenic factors like VEGF (vascular endothelial growth factor), which is increased in melasma skin lesions, compared with the surrounding skin. But it is unclear whether this is an epiphenomenon of the damage caused by sunlight or if you might have a role in the development of melasma.

Given the above, to develop a melasma seems to be interacting melanocytes and keratinocytes in the epidermis (the main pigment accumulation point) with fibroblasts and blood vessel cells of the dermis. Therefore, the treatment of melasma is more complicated than using a simple skin lightening cream. You have to use different combinations of treatments tailored to each patient’s skin, and avoiding overly aggressive procedures provided that the only thing that can make things worse and more expensive spot. It is necessary to use appropriate sunscreen daily, combined with habits to avoid peak sun exposure and use physical measures of photoprotection (large sunglasses, hat, etc). It is also essential to use cosmetics with active ingredients that prevent facial pigmentation. And finally, with caution, you can make professional treatments “shock” of an aesthetic nature or, if possible, medical, and chemical peels, laser, etc).

It is important that the patient knows that should not be neglected in preventive measures, because the bias and tendency to stain persists, so you’ll have to do maintenance treatments.