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REVIEW ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 21-27

Etiopathogenesis of melasma


1 SKINNOCENCE: The Skin Clinic and Research Centre, Gurgaon, Haryana, India
2 Department of Dermatology and STD, Maulana Azad Medical College, Lok Nayak Hospital, University of Delhi, New Delhi, India

Correspondence Address:
Sidharth Sonthalia
SKINNOCENCE: The Skin Clinic and Research Centre, C-2246 (Ground Floor), 'Suhridaya,' Sushant Lok-1, Block-C, Gurgaon - 122 009, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5847.159389

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Melasma is a notoriously recidivist condition with yet unclear etiopathogenesis. It seems to have a multifactorial origin with both genetics and environment playing an important role. A genetic predisposition is suggested by a high reported incidence in family members in certain racial groups. Among the environmental factors, exposure to ultraviolet and visible light constitutes the biggest risk factor. Onset or worsening of melasma during pregnancy and during or following intake of hormonal oral contraceptive pills suggest the involvement of hormonal factors. The role of cutaneous vasculature in its pathogenesis is suggested by presence of clinically appreciable telangiectatic erythema confined to the melasma lesional skin in many patients, a finding reinforced by dermatoscopic evaluation and detection of upregulated expression of vascular endothelial growth factor, in the lesional skin. Various other factors such as thyroid disorder, drugs, cosmetics, stress may exacerbate existing melasma in a subset of patients. Although the precise molecular pathogenesis of melasma remains mysterious, up regulation of inducible nitric oxide synthase and many melanogenesis-related genes and melanocyte markers such as TYR, MITF, SILV, and TYRP1, Wnt pathway modulator genes, genes of prostaglandin metabolic processes, and those regulating lipid metabolism seem to be operative. In summary, though the exact etiopathogenesis of melasma remain appalling, newer studies have provided corporeal evidence in favor of certain previously suspected and some novel factors. Further research in this area will not only provide more evidence for their involvement in the pathophysiology of melasma, but also offer attractive targets for development of newer treatment modalities. This article exhaustively reviews the validity of the previously postulated etiological factors based on hitherto-accrued evidence, and explores the newer suggested pathogenetic mechanisms, which may pave way for development of novel therapeutic strategies.


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