Melasma is not exclusive to any sex, age, or race. Melasma is rarely reported before puberty and is more common in women of reproductive age. Men comprise only 10% of the affected population.⁵ The condition is more prevalent among people with darker complexions (skin types IV to VI), including those of Hispanic, Middle Eastern, Asian, and Indian descent who live in areas of the world that receive high-intensity ultraviolet radiation.²

While most cases are idiopathic, melasma can also be associated with genetics, exposure to ultraviolet radiation, pregnancy, oral contraceptives, hormone replacement therapies, mild endocrine disturbances (ie, ovarian or thyroid dysfunction), cosmetics, antiepileptic medications, and other photosensitizing drugs.^2,6,7 Melasma is commonly reported in women using estrogen-progesterone oral contraceptives, hormone replacement therapy for prevention of osteoporosis, and in men using an estrogen derivative for treatment of prostate cancer.³ An endocrinologic study of women with melasma who had never been pregnant nor used oral contraceptives reported increased serum concentrations of luteinizing hormone, which could implicate mild ovarian dysfunction as a possible cause of idiopathic cases of melasma.⁶ Sun exposure tends to be the most important causative factor in all patients, so management options for melasma must always include protection from the sun and avoidance of excessive exposure to sunlight.

In recent years, attempts have been made to use pigmented lesion dye, Q-switched Nd:YAG, Q-switched ruby, and argon and carbon dioxide lasers; however, studies using these instruments have achieved only moderate success.^3,7,8 Lasers are typically used after hypopigmenting and exfoliative therapeutic options have been considered. In some cases, melasma spontaneously disappears several months postpartum or after cessation of oral contraceptives. If appropriate, discontinuation of causative medications is indicated. Treatment and prevention of melasma should always include avoiding excessive exposure to the sun and daily application of broad-spectrum sunscreens, preferably those containing opaque physical blockers, such as titanium dioxide and zinc oxide. Consultation with a dermatologist for therapeutic options is recommended.