Another name is chloasma. They are large, light to dark brown blotchy patches. They develop, usually symmetrically, slowly over the forehead, cheeks and moustache area.

No one knows how it comes on but it occurs most commonly during pregnancy and can be related to the use of contraceptive pills. The chance is as high as 50 to 70% in pregnant women and 8 to 29% in women taking the pills. They fade after delivery or stopping the pills, but may be permanent. Again they become more obvious after sun exposure.

There are 3 types of melasma: superficial (we call it epidermal type); deep (dermal type); and the mixed (epidermal-dermal type). The doctor can tell the difference by shining ultra-violet light on it. The main thing is that only the superficial part can be effectively treated with bleaching agents.

Melasma is notoriously difficult to treat with the various pigment lasers. Frequently it may not respond, and in some cases it may actually worsen. However, with the new addition of fractional lasers, particularly the CO2 laser, there is a new hope. It has been shown that after 2-6 treatments, there is a marked reduction in both epidermal and dermal pigmentation, with no relapse after 3 months.