The common skin condition melasma presents in both male and female patients yet disproportionately affects dark-skinned individuals, including those of Latino and African descent, as well as those who live in areas of high sun exposure. Hyperpigmentation can be a cause of cosmetic concern for many patients, regardless of gender or ethnicity. However, because melasma is more prevalent in women of childbearing age, there is a significant body of research on its pathophysiology and therapeutic strategies in that patient population and a paucity of studies conducted in male patients.
Although melasma is less prevalent in men, it can have an equally detrimental effect on quality of life as it does in female patients. Despite similarities in presentation, the skin disorder can exhibit differences in clinical, etiological, and treatment aspects in male patients that require further study. Greater knowledge of the unique characteristics of melasma presentation in male patients can allow for the improvement of management strategies in this group.
New research aims to elucidate the differentiating factors that clinicians should keep in mind while treating male patients with melasma and discuss important clinical aspects associated with the condition.
Melasma in Male Patients
Led by Rashmi Sarkar, MD, MNAMS, the research team conducted an extensive literature review of articles published on PubMed and Cochran Library that contained the keywords melasma, etiology, and men from the past 20 years. Exceptions were made to include older publications that were needed to describe the evolution of melasma in men, while studies that were poorly designed or presented conflicting results were excluded.
Overall, the global prevalence of melasma was unknown, however, the investigators found that incidence varied alongside factors such as ethnicity, skin type, and levels of sun exposure. The researchers found that in male melasma patients in particular ethnicity played a bigger role than was previously thought. In addition, while melasma generally presents similarly in men and women, the authors noted that the malar clinical pattern for melasma is most commonly found in men and the centrofacial pattern occurs more frequently in female patients.
As in the majority of demographics, managing melasma in male patients usually requires medical treatment modalities, often including topical therapy with a triple combination cream.
“Monotherapies and dual therapies have lower efficacy, slower onset of action, and are recommended to patients unable to access triple therapy or who have sensitivity to the ingredients,” the study’s authors noted.
Additionally, chemical peels are commonly used as a part of melasma treatment, however, researchers caution against the use of these methods on darker skin types due to risks of hyperpigmentation. Importantly, the review also noted that men report increased levels of sun exposure compared with women – 49% of male patients versus 24% female – which is a factor to consider when discussing treatment options with male melasma patients who seek treatment as they need to understand the need to wear sun protection both during and after treatment to prevent recurrences.
Treatment Compliance Concerns
The issue of treatment compliance is most common in male patients as men are typically less compliant with complicated skin care regimens. “Clinicians should bear in mind that if a male patient is seeking treatment for a dermatological condition, such as melasma, then cosmesis might at least be of partial concern to him, and thus the patient might be very motivated to adhere to a prescribed treatment regime,” the study’s authors wrote.
Considering factors such as fragrance, moisture levels, necessary steps, and applications is important in determining a treatment plan for this patient group to ensure compliance.
The latest review recommends clinicians educate their patients on the causes, prevention, treatment methods, and recurrence rates of melasma regardless of gender. Based on the evidence, clinicians should take into consideration patient preferences and expectations in developing a melasma treatment strategy for male patients in particular – these factors may differ significantly from those of their female counterparts.