Melasma is abnormal pigmentation on the face, most often in women who are pregnant or on birth control pills. It is also known as “the mask of pregnancy”. It is characterized by irregular brown patches on the face, most commonly on the forehead and cheeks.
Pigmentation from melasma can be difficult to treat. Excellent sun protection with physical sunscreens (zinc oxide and titanium dioxide), sun protective hats and clothing, and sun avoidance are all important. Bleaching creams with hydroquinone are the standard treatment. Hydroquinone 2% cream can be bought over-the-counter. Hydroquinone 4% cream is more effective and requires a prescription. Tretinoin (otherwise known as Retin-A) can be added to increase effectiveness. Sometimes 4% hydroquinone is not strong enough, and in that case a pharmacist can “compound” a higher strength hydroquinone. Various chemical peels can be used as treatment as well.