Sun-related patches of the melasma type are brown, non-congenital patches usually seen on the face. Although they are usually seen on the forehead, chin and upper lip, they can appear anywhere on the body. They are more common in women with relatively darker skin.

On the face they are often bilateral and symmetrical. Histologically, melasma is divided into superficial, deep and mixed types. Superficial melasma responds better to treatment. Sun exposure, pregnancy, hormone treatments and contraceptive pills trigger melasma. Melasma seen during pregnancy is called the "mask of pregnancy" or "chloasma". Although the cause of these patches is not fully known, genetic factors, hormonal changes, sensitivity to light and prolonged sun exposure are known to be associated with melasma.

Melasma is a very common problem. Its incidence is high in young women, and it occurs more often in people with darker skin. Its cause is unknown. Thyroid diseases may often be seen in people with melasma; however, no definite link between melasma and thyroid disease has been established.

Depending on where the pigment is located, melasma is divided into superficial, deep and mixed types. Deep melasma is dark brown to bluish in colour with ill-defined borders, while superficial melasma lesions are brown with sharp borders. Mixed types may be brownish-grey. Deep-seated melasma responds less well to treatment, while the response is better in superficial types.

Where on the face does melasma occur?
The cheeks, forehead and upper lip are the most common areas. Melasma patches usually darken in summer and lighten in winter. Some melasma patches stay dark in both summer and winter, which is a sign that the pigmentation is deep.

What causes melasma?
* Pigment-producing cells in the skin called melanocytes produce more melanin pigment locally. There is only an increase in pigment production, without an increase in the number of cells.
* Genetic predisposition plays an important role. It is seen more often in Asian and Middle Eastern people.
* Sunlight makes melasma more prominent.
* It is seen more often in those taking contraceptive pills and hormone replacement therapy.

How is melasma treated?
Before treatment, the depth of the pigmentation is determined with a Wood's lamp. Combined approaches increase the chance of success in treatment. As well as topical lightening agents, antioxidant supplements and laser treatments increase the chance of success.
The priority in treating melasma is strict sun protection of the skin and preventing the pigmentation from darkening.

1. Regular use of lightening agents such as tretinoin, kojic acid, hydroquinone and vitamin C,
2. Regular peel treatments,
3. Dermatherapy together with the application of a lightening serum,
4. Laser treatments
a) IPL
b) Pulsed dye laser (510 nm)
c) Q-switched ruby laser (694 nm)
d) Q-switched alexandrite laser (750 nm)
e) Q-switched Nd:YAG laser (1064 nm)
f) Ruby laser
5. PRP
6. Mesotherapy