Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.

What causes melasma?

The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called the "mask of pregnancy." Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition.

Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs can stimulate pigment-producing cells, or melanocytes in the skin. Incidental exposure to the sun is mainly the reason for recurrences of melasma.

How is it treated?

While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy; it may remain for many years, or a lifetime.

Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 30 or higher should be selected. In addition, physical sunblock lotions and creams such as zinc oxide and titanium dioxide may be used to block ultraviolet radiation and visible light. Sunscreens should be worn daily, whether or not it is sunny outside, or if you are outdoors or indoors. A significant amount of ultraviolet rays is received while walking down the street, driving in cars, sitting next to windows.

Any facial cleansers, creams, or make-up, which irritates the skin, should be stopped, as this may worsen melasma. If melasma develops after starting birth control pills, it may improve after discontinuing them. Melasma can be treated with bleaching creams, while continuing the birth control pills.

A variety of creams are available for the treatment of melasma.

• Hydroquinone (Melanex, Solaquin Forte) ______________________________________
• Azeleic acid _____________________________________________________________
• OBAGI __________________________________________________________________
• Sunscreen recommendation ________________________________________________