Abstract
Melasma is an acquired, symmetrical, and circumscribed hypomelanosis presenting with light to dark brown macules on the face and occasionally on the neck and forearms. It is derived from the Greek word “melas” meaning black, which refers to its brownish clinical presentation(1).
Melasma is a complex skin condition influenced by multiple factors. Genetic predisposition plays a significant role, with studies indicating that nearly half of individuals with melasma have a family history of the condition, particularly among first-degree relatives. Hormonal changes are also a key contributor; for instance, increased levels of estrogen and progesterone during pregnancy can trigger melasma, a phenomenon often referred to as the “mask of pregnancy”. Additionally, sun exposure is a major environmental factor; ultraviolet (UV) radiation stimulates melanocytes to produce excess melanin, leading to the development or worsening of melasma.(2–4). In histopathology, there is an increase in epidermal melanin and melanosome number and transfer in epidermal melasma. However, melanophages are visible in the superficial and deep dermis in dermal melasma(5,6). The use of cosmetics at least five times a week contributes to the exacerbation of melasma among the Indian population. Melasma is a common pigmentation disorder among Indians. Malar pattern melasma is predominant in the southern region of India to a greater extent when compared with the northern region(7).
Melasma is frequently seen in women (90%) with pregnancy or use of oral contraceptives in their reproductive years. Up to 10% of cases, diagnosed as melasma all over the world, occur in men. The prevalence of melasma in men in India is 20.5%(8).
The key strategies for the treatment of melasma include slowing the growth of pigment-producing cells, preventing the formation of pigment particles, and promoting the breakdown of existing pigment particles. The management of melasma depends on the pigmentation type, severity, and the patient’s lifestyle, with physicians focusing on eliminating risk factors, protecting against ultraviolet rays, and using topical products to lighten the skin. While topical treatments provide short-term relief; the condition often reappears. The primary aim is to block melanin production, prevent the transfer of melanosomes, and enhance melanin elimination. However, traditional allopathic treatments, such as hydroquinone, retinoids, and corticosteroids, can cause undesirable side effects, including irritation, increased sun sensitivity, and skin thinning(9).
In the modern mode of treatment, it is considered melasma is one local disease or external disease which is treated by external interference which is the final treatment. Treatment of melasma includes topical demalanising agents with particular emphasis on photoprotection. Chemical peels and laser therapy are the other modalities used(10). But any disease impacts the patient at every level of health—mental, emotional, and physical—and should be talked about accordingly. Homeopathy is based on the law of similia and emphasizes treating the patient as a whole(11).
Case Study:
The reported case is of 35 years old, female, Hindu, Housewife, residing in a rural area and belonging to a middle-class family, who came to our OPD 5334/54337 on 11/01/2024 with the following complaints 4 years:
1. Hyperpigmented spot on both cheeks, forehead and nose
2. Headache right-sided << heat, sunlight, fasting. Treatment History – She took allopathic treatment face creams for pigmentation but complaints were not relieved.
Family History – Mother had hyperpigmentation on her face, and Father is suffering from hypertension.
Physical Generals
Appetite- 4 chapati/ meal, 2 Meals, satisfactory.
Desire – salty food.
Thirst- great thirst, drinks 3-4 litres/day.
Stool- once a day, constipation with difficult to pass.
Urine- Pale yellow, non-offensive.
Perspiration- Profuse, non-offensive, non-staining.
Thermal reaction- Hot.
Sleep/Dreams- 8 hours/day, sound and dreams of robbery.
Mentals– The patient was irritable, reserved, shy and not expressing herself. Weeps when alone and if someone tries to console her, she gets angry. She does everything in a great hurry.
General examination: The patient was apparently healthy-looking. Anaemia – Absent, facies- absent, cyanosis- absent, oedema – absent, skin- dry, emaciation-present, tongue- white coated, weight – 58kg, SpO2- 97%, temperature – Afebrile, height – 160cm, built – good build, blood pressure- 110/70 mm Hg, respiratory rate – 18/ min, Pulse-84/min.
Local examination: Dark brown, irregularly shaped patches on cheeks, nose and forehead. No itching
Evaluation and Analysis of symptoms. Symptoms Evaluation Miasmatic analysis
Timidity +2 psora
Weeping < consolation +3 Sycotic
Hurried +3 Psora
The desire for salty food +3 psychotic
Constipation with difficult stool +2 Psora
Brown Discolouration of face +2 psychotic
Headache << sun heat, daytime +1 Psora
Repertorisation
After analysis and evaluation of the case, the following rubrics were taken for repertorisation [Figure 1].
Selection of medicine: – Natrum Mur 200 single dose along with Placebo 30 /OD was prescribed for 30 days.
General Management –
Eat green leafy vegetables
Drink plenty of water
Wear protective clothing
Avoid hormonal birth control
Avoid direct sunlight for long hours.
Take a good, nutritious diet, increase fiber intake.
Do moderate physical exercise
Follow up
Table 1: The patient was followed up every month
| Date | Symptoms & Response | Prescription | Remarks |
| 14/02/24 | Patches of discolouration on both cheeks and nose slightly darken in colourPatient feels mentally good | SL 200/30 days | No relief |
| 12/03/24 | Patches of discolouration on both cheeks and nose seem reduced in size, and darkness was reducedImprovement in pain in the head. | SL 30/bd/30 days | Relief |
| 15/04/24 | The size and pigmentation of the discolouration were further reduced. The patient is mentally calm and good.No new episode of headache | Nat mur 200 single doseSL 30/bd/30 days | Relief |
| 11/06/24 | Marked reduction of the skin pigmentation was seen. Good sleep and appetite. | SL 200/bd/30 days | Relief |
ASSESSMENT BEFORE AND AFTER TREATMENT
Table 2: Assessment by modified MELASMA AREA AND SEVERITY INDEX (mMASI Scale):
| Percentage of area affected % | BEFORE | AFTER |
| Forehead | 4 | 2 |
| Left cheek | 5 | 3 |
| Right cheek | 5 | 3 |
| Chin | 4 | 2 |
| Darkness of Pigmentation (D | ||
| forehead | 3 | 1 |
| Left cheek | 3 | 2 |
| Right cheek | 3 | 1 |
| chin | 3 | 1 |
| mMASI SCORE = | 14 | 3.4 |
Figure 2: shows the Centro-facial pattern type of melasma before treatment 
Figure 3: After treatment
References
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2. Majid I, Aleem S. Melasma: Update on Epidemiology, Clinical Presentation, Assessment, and Scoring [Internet]. Journal of Skin and Stem Cell; 2021 [cited 2025 Jun 18]. Report No.: 8. Available from: https://brieflands.com/articles/jssc-120283#abstract
3. Liu W, Chen Q, Xia Y. New Mechanistic Insights of Melasma. Clin Cosmet Investig Dermatol [Internet]. 2023 Feb 13 [cited 2025 Jun 18];16:429–42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9936885/
4. Verywell Health [Internet]. [cited 2025 Jun 18]. An Overview of Melasma. Available from: https://www.verywellhealth.com/melasma-overview-4588702
5. Arefiev KLB, Hantash BM. Advances in the Treatment of Melasma: A Review of the Recent Literature. Dermatologic Surgery [Internet]. 2012 Jul [cited 2025 Jun 18];38(7 pt1):971. Available from: https://journals.lww.com/dermatologicsurgery/abstract/2012/07010/advances_in_the_treatment_of_melasma__a_review_of.1.aspx
6. Kotekar S, Thappa DM. Facial dyschromias: A review of clinical and dermoscopic features. CosmoDerma [Internet]. 2024 Oct 24 [cited 2025 Jun 18];4. Available from: https://cosmoderma.org/facial-dyschromias-a-review-of-clinical-and-dermoscopic-features/
7. KrupaShankar DSR, Somani VK, Kohli M, Sharad J, Ganjoo A, Kandhari S, et al. A Cross-Sectional, Multicentric Clinico-Epidemiological Study of Melasma in India. Dermatol Ther (Heidelb) [Internet]. 2014 Jun 1 [cited 2025 Jun 18];4(1):71–81. Available from: https://doi.org/10.1007/s13555-014-0046-1
8. Sarangi S, Das K, Padhi T. Clinical and Dermoscopic Evaluation of Melasma in Men- An Observational Study at a Tertiary Health Care Centre in Western Odisha, India. JCDR [Internet]. 2023 [cited 2025 Jun 18]; Available from: https://www.jcdr.net//article_fulltext.asp?issn=0973-709x&year=2023&volume=17&issue=2&page=WC05&issn=0973-709x&id=17522
9. Damevska K. New Aspects of Melasma/Novi aspekti melazme. Serbian Journal of Dermatology and Venereology [Internet]. 2014 Mar 1 [cited 2025 Jun 18];6(1):5–18. Available from: https://www.sciendo.com/article/10.2478/sjdv-2014-0001
10. Majid I, Aleem S. Melasma: Update on Epidemiology, Clinical Presentation, Assessment, and Scoring [Internet]. Journal of Skin and Stem Cell; 2021 [cited 2025 Jun 18]. Report No.: 8. Available from: https://brieflands.com/articles/jssc-120283#abstract
11. Hahnemann SCF. Organon of Medicine, Tr. by R.E. Dudgeon. LEGARE STREET Press; 2023. 376 p.
Author
Dr Omprakash Patidar 1 *, Dr Manoranjan Kumar 1 , Dr Babita Shrivastava 2
1 PG Scholar, Department of Organon of Medicine & Homoeopathic Philosophy, Govt. Homoeopathic Medical College and Hospital, Bhopal
2 PG Scholar, Department of Case Taking and Repertory, National Institute of Homoeopathy, Kolkata, Govt. of India.
3 Prof & Hod Department of Organon of Medicine & Homoeopathic Philosophy, Govt. Homoeopathic Medical College and Hospital, Bhopal
