A 24-year-old woman is evaluated for a rash on her face for several months’ duration. The rash isn’t bothersome but has gotten worse over the summer. She washes her face with soap and water twice daily and has recently changed soaps. Previously her skin was normal. She is otherwise healthy. Her only medication is an oral contraceptive pill, which she started 3 months ago. (Image source: MKSAP)
What is this rash? What causes it? How do we treat it?
Melasma is most often triggered by UV radiation, genetic predisposition, and hormonal influences (e.g. pregnancy, OCPs). These triggers lead to increases in melanin biosynthesis.
Treatment focuses on strict sun protection, avoidance of triggers, and possibly bleaching agents. Other pharmacologic interventions can include hydroquinone, tretinoin, and glucocorticoid topical creams.