It's a common problem many women (and men) battle everyday - melasma.  These brown patches usually show up on the forehead, cheeks, upper lip, and chin area.  Women tend to be affected more often than men.  No one knows exactly what causes it, but we do know that there are certain factors that seem to trigger the increase in pigmentation.  Sun exposure and estrogen are the two biggies.  Birth control pills, hormone replacement therapy, and pregnancy (in which case it is called chloasma, or the mask of pregnancy) rev up melanocytes to produce more melanin, which is responsible for pigment in the skin.

Melasma is a difficult condition to treat.  Like many other conditions in dermatology (psoriasis, eczema, acne) there is no cure.  A combination of topical medications and procedures are used to improve it, but results need to be maintained.  The single most important factor is sun exposure.  People with melasma MUST protect their skin from the sun.  Sun avoidance, suncreen, sun protective clothing: the whole nine yards.

The gold standard in topical treatments is the lightening cream hydroquinone.  Donna Bilu Martin, MD, often prescribes Triluma, which is a combination hydroquinone/retinol/steroid.  It is very effective, and must be used under a physician's supervision.  It is often cycled every few months with other topical treatments that do not contain hydroquinone, such as SkinCeuticals Advanced Pigment Corrector. 

In addition to topical treatments, light chemical peels can be performed in the doctor's office.  However, care must be taken to avoid hyperpigmentation (darkening of areas).  Dr. Bilu Martin performs the Vi Peel and glycolic acid peels for suitable patients.  The 1540 nm non-ablative fractional laser on the Palomar Icon Aesthetic Platform, available at Premier Dermatology, MD also improves melasma.

Just as exercise and diet are used to help maintain a healthy weight, strict sun protection and various dermatologist-prescribed treatments can help maintain skin.