Melasma

Melasma, also called chloasma, is a disorder where dark or hyperpigmented patches appear on the skin. It usually affects the face. Common areas of involvement include the cheeks, forehead, upper lip, and jaw line. Women are affected about ten times as often as men. It is more common in patients with darker skin tones such as those with ancestry from the Middle East, Southeast Asia, Africa, and South America. Melasma is sometimes called the mask of pregnancy because it can be induced by hormonal changes that occur during pregnancy, and also around menopause. Other causes include sun exposure, genetic predisposition, contraceptive medications, other medications such as dilantin, or unknown or idiopathic causes.

Melasma sometimes goes away spontaneously, that is without any treatment. But when it doesn't, it may be difficult to treat. Bleaching agents such as hydroquinone are the mainstay of treatment. Hydroquinone is available over-the-counter at 2% strength. Usually stronger doses are needed; these require a prescription. Other, less effective, bleaching agents include azelaic acid, kojic acid, and licorice extract. The use of daily sunscreen is also mandatory. Sunscreens with SPF of at least 30 with UVA and UVB protection are recommended by the American Academy of Dermatology. Other medical treatments include retinoids such as retin-A. Procedural treatments which are often used in conjunction with medications include chemical peels and laser therapy.

Below are pictures of patients with melasma who saw improvement after 12 weeks of using the Obagi Nuderm Condition and Enhance system, which contains a cleanser, toner, exfoliant, sunscreen, and 4 % hydroquinone.