Chloasma

Chloasma, commonly known as melasma in contemporary medical terminology, is a pigmentary disorder characterized by symmetric brown to gray-brown macules and patches on sun-exposed areas of the face. It most often affects women of reproductive age and is associated with hormonal and ultraviolet triggers, such as pregnancy or the use of estrogen-containing contraceptives or hormone therapy.

Pathophysiology involves increased melanin production and melanocyte activity influenced by ultraviolet radiation and hormonal factors. Many cases show a combination of epidermal and dermal pigmentation. Genetic predisposition and sun exposure contribute to susceptibility, and the condition may be persistent or recurrent.

Clinical features include symmetrical patches on the cheeks, forehead, upper lip, and chin with irregular borders. A Wood lamp can help assess pigment depth in some cases, though the distinction between epidermal and dermal involvement is not always clear. Diagnosis is typically clinical.

Management emphasizes sun protection and depigmenting therapies. First-line measures include daily broad-spectrum sunscreen and topical agents such as hydroquinone, azelaic acid, kojic acid, or retinoids. In refractory cases, chemical peels or laser therapies may be considered. During pregnancy or lactation, treatment options are limited and hydroquinone is usually avoided; chloasma often improves after delivery, but relapse is common with subsequent pregnancies. Long-term prognosis varies, with lesions potentially persisting for months to years and frequently recurring if sun exposure or hormonal triggers are ongoing.