Melasma appears as a symmetrical blotchy, brownish pigmentation on the face. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes. It can lead to considerable embarassment and distress. The cause of melasma is complex. There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected. In most people melasma is a chronic disorder. There are several known triggers for melasma: sun exposure (the most important avoidable risk factor), pregnancy, hormone treatments (including oral contraceptive pills), scented or deodorant soaps, toiletries and cosmetics, etc. More commonly, it arises in apparently healthy, normal, non-pregnant adults and persists for decades. Exposure to ultraviolet radiation (UVR) deepens the pigmentation because it activates the melanocytes. Melasma can be very slow to respond to treatment, so patience is necessary. Start gently, especially if you have sensitive skin. Harsh treatments may result in irritant contact dermatitis, and this can result in postinflammatory pigmentation.