Dermatology 2026

Melasma is a chronic, multifactorial pigmentary disorder with a high tendency for recurrence and significant therapeutic challenges. Its pathogenesis involves complex interactions between ultraviolet and visible light exposure, genetic susceptibility, hormonal influences, inflammation, vascular factors and altered melanogenesis. Successful management therefore requires more than isolated pigment suppression and should address the multiple mechanisms contributing to disease persistence. This presentation provides a practical, evidence-based approach to the assessment and management of melasma, with particular emphasis on individualized and combination treatment strategies. Conventional therapies including photoprotection, topical depigmenting agents, antioxidants, tranexamic acid and chemical peels are discussed alongside evolving procedural approaches for resistant and recurrent disease. A key focus is the growing role of targeted intradermal and transdermal drug delivery. Techniques such as microneedling, mesotherapy, electroporation and energy-assisted drug delivery can enhance penetration of active ingredients, increase local therapeutic concentrations and potentially reduce systemic exposure. These approaches may be particularly valuable in patients with refractory melasma and in skin of colour, where minimizing inflammation and post-procedural dyspigmentation is essential. The presentation further explores the rationale for combining topical, systemic and procedural therapies rather than relying on monotherapy. Evidence suggests that appropriately selected combination approaches can improve clinical response while helping reduce treatment-related complications and recurrence. Ultimately, effective melasma management should be individualized according to skin phototype, disease severity, contributing factors and previous treatment response. Long-term photoprotection, patient education, trigger avoidance and maintenance therapy remain fundamental to achieving sustained clinical outcomes

Dr. Erum Siddiqui, MBBS, FCPS (Dermatology) is a Consultant Dermatologist with expertise in the diagnosis and management of a wide range of dermatological conditions. She is dedicated to providing patient-centered care and applying evidence-based approaches in clinical dermatology. Through her clinical experience and professional involvement, she contributes to advancing knowledge and improving outcomes in dermatological care.