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Dark pigment that develops symmetrically on the forehead cheeks and upper lip may be melasma. It primarily affects women, but 5-10% of cases are in men. It is a condition thought to be triggered by hormones, sunlight and heat.

It’s important to realize that melasma is a chronic condition that has no cure. There are many methods to treat melasma and prevent it from getting worse.

Any regimen to treat melasma must include religious sunscreen use. Topical fading creams are useful. The most effective includes hydroquinone, tretinoin and a mild steroid. However, other creams can be useful as well. These include azelaic acid, tranexamic acid, vitamin C, glycolic acid, salicylic acid and nicotinamide. Alpha hydroxy acid washes can increase cellular turnover, and help fade brown patches.

Chemical peels, both superficial and medium strength, are effective at rapidly clearing melasma. Many types are available. 

Lasers and light based therapies are sometimes used to treat melasma. These must be used with caution as increased pigmentation and rebound darkening can occur. Intense Pulsed Light (IPL) and Q-switched non-ablative laser treatments should be performed under the direction of a board certified dermatologist. 

Because melasma is a chronic condition, you should consult with a dermatologist to develop a plan to control it. 

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-Daniel Hansen, DO