PRESERVATION OF THE SKIN BARRIER IN THE THERAPEUTIC APPROACH TO MELASMA

Abstract

aimed to conduct an evidence-based review of available interventions for the treatment of melasma that, in addition to depigmentation, consider the restoration of the cutaneous microenvironment and the preservation of the epidermal barrier as central components of the therapeutic approach. To this end, an integrative literature review was deemed pertinent, using searches of articles indexed in the MEDLINE, LILACS, and SciELO databases. The findings in the literature demonstrated that melasma is not solely a pigmentation disorder, as its pathogenesis involves functional alterations of the cutaneous microenvironment, mainly related to the integrity of the epidermal barrier. Therefore, the focus of exclusively depigmenting treatment shifts to an approach focused on restoring the cutaneous microenvironment and the functional stability of the stratum corneum, which has proven essential for improving clinical outcomes and reducing relapses. In this sense, therapies that promote the repair of the lipid matrix of the stratum corneum are proposed, such as the application of formulations containing ceramides, cholesterol, and essential fatty acids. Additionally, rigorous photoprotection and the paradigm of preserving the integrity of the epidermal barrier are indicated, through the use of therapeutic agents with less irritant potential such as tranexamic acid, whose effectiveness has been demonstrated.