Melasma

Melasma is a common acquired hyperpigmentation of the skin characterized by symmetric, flattened brown to gray-brown patches, most often on sun-exposed facial areas such as the cheeks, upper lip, forehead, and chin. It can also occur on other sun-exposed sites. It is more prevalent in women, especially during reproductive years, and occurs more frequently in people with darker skin tones. It is also referred to as chloasma or the “mask of pregnancy.”

The condition has a multifactorial cause. Ultraviolet radiation is a major trigger, and hormonal factors such as pregnancy, use of oral contraceptives or hormone therapy can influence its appearance. Genetic predisposition, photodamage, and some inflammatory skin conditions may contribute. Melasma is not dangerous, but it can be persistent and cosmetically distressing.

Diagnosis is usually clinical. A Wood’s lamp examination can help differentiate epidermal versus dermal involvement, though histopathology is rarely required.

Management focuses on reducing pigment and preventing recurrence. Sun protection is essential, including broad-spectrum sunscreen with high SPF, protective clothing, and limiting sun exposure. Topical depigmenting agents such as hydroquinone, tretinoin, azelaic acid, kojic acid, or corticosteroids (in combination regimens) are commonly used. Chemical peels and energy-based therapies may improve appearance but carry a risk of rebound hyperpigmentation, particularly in darker skin types, and should be performed by experienced clinicians. Maintenance therapy is often long-term, with ongoing sun protection.

Prognosis varies; melasma tends to recur or persist despite treatment, requiring ongoing management. Research continues into safer, more effective therapies and laser options.