Melasma is a skin condition commonly seen in women but is also seen in men. It is characterised by the presence of brown patches over the facial skin, usually the cheeks and also on the forehead, bridge of the nose and upper lip. It is most common in darker skin. It is seen in the ages between 20 and 40 years but can appear in any age group even in young children

The brown discoloration is due to overproduction of the skin pigment known as melanin. The causes are multifactorial but there is usually a family history of similar pigmentation. The main relationship of melasma has been noted with an underlying hormonal factor, such as during pregnancy and women who take oral contraceptives or undergoing hormonal treatment. Sun exposure is also known to be a factor and certain medications can also precipitate this type of pigmentation. Sometimes use of soaps or face care products can also lead to similar pigmentation mainly due to skin irritation.

Treatment is usually slow and difficult. A number of topical agents have been tried. The most successful combination is usually a combination of a bleaching cream with a mild topical steroid and a topical retinoid cream. Lasers are also used and so too intense pulsed light. Any treatment has the potential to cause irritation and hence produce post inflammatory hyperpigmentation which can complicate the outcome. Prevention with a sunscreen all through the year is ideal and consideration should be given to cosmetic camouflage.

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