Melasma is a Greek word that means "black spot." Melasma is of unknown cause in some cases but is influenced by hormones and exposure to sunlight. This condition appears most commonly in dark-haired, dark-skinned women. Pregnancy or use of birth control pills can lead to melasma. If melasma is caused by pregnancy or by birth control pills it can take up to five years to disappear or can last indefinitely. The resulting hyperpigmentation can affect any or all of the following facia! areas: the forehead, cheeks, nose, upper lip, and chin. Wearing perfume or certain cosmetic facial preparations in the sun can also worsen melasma.

Medical Treatment: Hydroquinone is prescribed to help fade the mottled liver spots caused by melasma. When combined with Retin-A hydroquinone is very successful in depigmenting discoloration caused by melasma. Sunscreen are also used to prevent repigmentation. Freezing with liquic nitrogen or dry ice can also lighten pigment. Electrosurgica: destruction or a mild acid is an alternative form of treatmen: that has been used to eliminate melasma.

Cosmetic Treatment: Patients should be encouraged to apply a total sunblock to the affected area daily to prevent further discoloration. This should be done twenty minute before the patient applies an opaque cover cream solution to, conceal the discoloration. Opaque cover creams with total sun protection (SPF of 15 or more) will cosmetically camouflage the hyperpigmented areas, and at the same time provide the patient with additional sun protection. Patients should bc

instructed to apply a thick application of cover cream so the discoloration will not bleed through and alter the color of the makeup, giving it a grayish cast. A terracotta or pink powder blush can be applied lightly to counteract this problem and will prevent it from looking muddy.