Melasma, also called "Mask of Pregnancy," occurs as brown patches on the face and forehead.  It occurs most often during pregnancy, with oral contaceptive use, and sometimes at menopause, especially after administration of estrogen.  Occasionally the use of the drug, Dilantin, may also cause melasma.

After pregnancy, melasma usually clears within a few months.  After stopping oral contraceptives, several years may be required before spontaneous improvement is noted.  Sometimes melasma is permanent. Therapy will be much more effective if oral contraceptives or estrogen are discontinued.

Treatment involves two equally important facets: 1) the use of bleaching medications, and 2) avoidance of sun exposure.

Bleaching Medication:

Fading of melasma can often be accomplished by the use of medications applied to the skin that contain a bleaching medication called hydroquinone.  This works well if the excess brown pigment is located in the top layer of the skin.  However, if the pigment is deeper in the skin, results are less pronounced.  

The hydroquinone should be applied twice daily to the dark areas only.  If applied to normal skin, it may also lighten these areas.  TriLuma cream (prescription required) contains hydroquinone along with Retin-A, a combination that has shown very good results in treating this condition.

Avoidance of Sun Exposure:

Application of topical Vitamin C serum and Vitamin E lotion twice daily can help lighten the pigmentation as well as protect against ultraviolet exposure from the sun.  Broad spectrum sunscreens should also be applied to the pigmented areas before heading outdoors, and of course, a hat and other protective clothing are a must, if this condition is to be improved.  For more information, please see Sunscreens article.

Some improvement may also be seen after laser resurfacing, although melasma usually returns if hydroquinone is discontinued.