Melasma is a common, acquired, chronic cutaneous pigment disorder that is often difficult to treat and has a high recurrence rate. The goal of a melasma treatment regimen is to decrease pigment production and increase elimination. Topical tyrosinase inhibitors block melanin synthesis and thereby reduce pigment production. Peels and laser- and light-based devices increase melanin elimination. A multimodality treatment approach targeting both pigment production and elimination is necessary to achieve equilibrium and disease remission. Maintenance treatments are often necessary due to the high recurrence rate. Strict photoprotection is critical to prevent melanogenesis and rebound. Targeting the vasculature via pulsed dye laser or tranexamic acid is another approach to treatment.
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