Melasma is a common acquired pigmentary disorder and is particularly seen among Asians and Hispanics. It is characterized by greyish-brown patches in areas of the face exposed to the sun, such as the forehead, cheeks, lips, and nose. Melasma has a psychological effect on affected patients and can reduce their quality of life. Since long, it has been a frustrating condition in terms of treatment for both dermatologists and patients. Continuous strict sun protection and avoding other triggers are essential. Hydroquinone is the most commonly used agent in topical monotherapy. A topical triple-combination formula is still the gold standard for treating melasma. Chemical peels and lasers lead to a high risk of post-inflammatory pigmentation. Oral tranexamic acid may be considered for those who fail or who only partially respond to conventional therapy; however, further studies are required to fully elucidate the efficacy and safety of this agent. Understanding dermal changes and the importance of vascularization in the pathogenesis of melasma will result in the development of new treatment options.
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