What is melasma?
Melasma is a chronic skin disorder that results in symmetrical, blotchy, brownish facial pigmentation. It can lead to considerable embarrassment and distress.
This form of facial pigmentation is sometimes called chloasma, but as this means green skin, the term melasma (brown skin) is preferred.

What causes melasma?
The cause of melasma is complex. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes, which is taken up by the keratinocytes (epidermal melanosis) and/or deposited in the dermis (dermal melanosis, melanophages). There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people melasma is a chronic disorder.

Known triggers for melasma include:

• Sun exposure and sun damage—this is the most important avoidable risk factor.
• Pregnancy—in affected women, the pigment often fades a few months after delivery.
• Hormone treatments—oral contraceptive pills containing oestrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women.
• Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics—these may cause a phototoxic reaction that triggers melasma, which may then persist long term.
• Hypothyroidism (low levels of circulating thyroid hormone) Melasma commonly arises in healthy, non-pregnant adults. Lifelong sun exposure causes deposition of pigment within the dermis and this often persists longterm. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes to produce more melanin.

Who gets melasma?
Melasma is more common in women than in men; only 1-in-4 to 1-in-20 affected individuals are male, depending on the population studied. It generally starts between the age of 20 and 40 years, but it can begin in childhood or not until middle-age.

What are the clinical features of melasma?
Melasma presents as macules (freckle-like spots) and larger flat brown patches.These are found on both sides of the face and have an irregular border. There are several distinct patterns.

• Centrofacial pattern: forehead, cheeks, nose and upper lips
• Malar pattern: cheeks and nose
• Lateral cheek pattern
• Mandibular pattern: jawline
• Reddened or inflamed forms of melasma (also called erythrosis pigmentosa faciei)

How is the diagnosis of melasma made?
The characteristic appearance of melasma means diagnosis is usually straightforward and made clinically.
Other disorders that may be considered instead of melasma or as well as melasma include:

• ostinflammatory pigmentation
• Solar lentigines and other forms of lentigo
• Drug-induced pigmentation
• Lichen planus
• Naevus of Ota and naevus of Hori

What is the treatment of melasma?
Melasma can be very slow to respond to treatment, especially if it has been present for a long time. Treatment may result in irritant contact dermatitis in patients with sensitive skin, and this can result in postinflammatory pigmentation.Dr nitin has treated so many patients who was suffered from melasma disease.