Melasma presents with brown patches on the cheeks, bridge of the nose, forehead and upper lip. It is most common in women with skin of color and occurs more frequently in those with a family history of the condition.
The three major factors known to bring out or worsen melasma are (1) hormonal changes associated with pregnancy or birth control pills, (2) ultraviolet light from the sun or even from strong light bulbs and (3) skin irritation of any kind.
If you have melasma, the most important part of treatment is a daily sunscreen that protects against UVA and UVB with an SPF of 30 or higher. Irritating skin products should be stopped and alternatives to birth control pills should be considered. The mainstay of topical treatment is with bleaching creams that contain hydroquinone or with compound products that also include a mild corticosteroid and a retinoid. In some patients, chemical peels and laser therapies may be recommended to accelerate improvement. It is important to remember that even minimal exposure to ultraviolet light can cause melasma to recur.