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Therapeutic Approach

Melasma is a common pigmentary disease caused by overactive melanocytes producing excessive melanin in the epidermis, which often migrates to the dermis. This leads to symmetric hyperpigmented macules and patches on sun-exposed areas of the face and sometimes the extensor arms. Types of melasma include centrofacial, malar, and mandibular, as well as epidermal, dermal, and mixed. Treatment is often difficult and recurrence rates are high. Initial management should focus on avoiding triggers: solar radiation and exogenous hormones. Choice of therapeutic strategies should be based on melasma type and severity. See Table 70-1.

Table 70-1Melasma Treatment Table

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