(1997; 132 pages) [French] [Spanish]
Melasma, which is characterized by the gradual development of symmetrical light-brown macules distributed in butterfly fashion on the nose, cheeks and forehead, typically occurs in dark-skinned people. It often appears during pregnancy in women living in dry, sunny climates, but is most frequently seen in those taking oral contraceptives. Melasma of pregnancy usually resolves a few months after delivery but, otherwise, spontaneous remission is rare.
Women who are not pregnant should be advised of the possible implications of oral contraceptive use. Sunscreens containing either p-aminobenzoic acid or benzophenones may attenuate the condition, provided that they have a sun protection factor (SPF) rating of at least 15. Topical preparations containing calamine, zinc oxide, titanium dioxide or other constituents which reflect incident light (physical sunblocks) can also provide useful protection when they are applied carefully.
Bleaching creams containing hydroquinone have been used with some success; however, they may produce persistent mottled hypopigmentation.