Melasma
Melasma produces brown or grayish-brown patches on the face, most often on cheeks, forehead, upper lip, and chin. It disproportionately affects women and darker skin tones.
Symptoms
Symmetric, irregularly bordered brown to gray-brown patches on sun-exposed facial areas. Pigmentation darkens with sun exposure and may improve in winter.
Causes and risk
UV radiation stimulates melanocyte overproduction. Hormonal factors -- pregnancy, oral contraceptives -- are strong triggers. Darker skin phototypes and heat also contribute.
How it is evaluated
Diagnosis is clinical. Wood lamp helps distinguish epidermal from dermal melasma. We review hormonal history and sun exposure to identify modifiable factors.
Treatment
Strict broad-spectrum sunscreen is the cornerstone. Topical triple combination cream (hydroquinone, tretinoin, corticosteroid) is first-line. Alternatives include azelaic acid and tranexamic acid. Our Chicago team creates maintenance plans.