Melasma is a chronic pigmentary disorder characterized by symmetrical, darkened patches on sun-exposed areas of the skin, most commonly the face. It predominantly affects women, particularly those of reproductive age, but can also occur in men. Although melasma is medically benign, it is often emotionally distressing due to its prominent facial involvement and tendency to recur.

The condition arises from increased melanin production and abnormal distribution within the skin. Hormonal influences play a central role, with pregnancy, oral contraceptives, and hormone therapies being common triggers. Ultraviolet radiation is a major aggravating factor, stimulating melanocyte activity and worsening pigmentation. Genetic predisposition and skin type also contribute to susceptibility.

Melasma typically appears as brown or gray-brown patches on the cheeks, forehead, upper lip, nose, and chin. Patterns may be centrofacial, malar, or mandibular. The pigmentation may be epidermal, dermal, or mixed, which influences treatment response and prognosis. Symptoms are usually limited to discoloration, without pain or itching.

Diagnosis is clinical, supported by assessment of pigmentation pattern and history of triggers. Differentiation from other causes of hyperpigmentation is essential to guide management and patient expectations. Because melasma is chronic and recurrent, treatment focuses on long-term control rather than permanent cure.

Management emphasizes strict sun protection, avoidance of triggering factors, and gradual pigment reduction. Patient education is critical, as inconsistent protection or premature discontinuation of care often leads to relapse. With a comprehensive and sustained approach, melasma can be significantly improved, restoring confidence and skin appearance.