Melasma (chehre ki chaiyan): causes and treatment in Pakistan

Melasma shows up as flat, brown to grey-brown patches, usually on both sides of the face in a matching pattern: the cheeks, forehead, bridge of the nose, upper lip and chin. The patches have no bumps, do not itch and are not pimple marks.

Pimple marks (post-acne dark spots) are different: they appear where a pimple was and fade on their own over weeks to months. Melasma patches are larger, spread in a pattern and tend to darken again every summer.

Sunlight is the biggest trigger: it makes skin produce more pigment, which darkens existing patches and starts new ones. This is why melasma is so common in Pakistan and why it often looks worse after summer.

Hormones are the second trigger. Melasma often starts during pregnancy or after starting birth control pills, because rising oestrogen and progesterone are thought to switch on pigment cells. Some medicines that make skin more sensitive to sunlight, tanning beds and possibly stress can also play a part.

Melasma is not caused by dirty skin and is not contagious. Harsh scrubbing, bleaching creams and irritation tend to make it darker, not lighter.

No cream or serum will keep melasma away if the skin keeps getting sun. Dermatologists recommend a broad-spectrum sunscreen of SPF 30 or higher every day, reapplied through the day when you are outdoors, along with shade and a wide-brimmed hat or a dupatta over the face.

If sunscreen leaves a white cast on your skin, a tinted sunscreen is a good choice. Use sunscreen on cloudy days too, and indoors if you sit near a sunny window.

Gentle brightening ingredients can fade the look of patches gradually, alongside sunscreen. Vitamin C is one of the gentler treatments dermatologists use for melasma, and niacinamide helps even out the look of discolouration. A mild AHA face wash lifts dull surface cells so the skin looks more even.

A simple routine: wash with a brightening face wash, apply a vitamin C serum in the morning under sunscreen, and use a niacinamide moisturiser at night. Avoid anything that stings or makes skin red, because irritation can darken melasma.

Expect slow results. Patches usually look lighter over 8 to 12 weeks of daily use, and the routine needs to continue to stop them returning.

See a dermatologist if patches are dark or spreading, if they appeared after starting a new medicine, or if a few months of sunscreen and brightening care have not helped. They can confirm it is melasma and prescribe treatment such as hydroquinone, tretinoin, a triple combination cream or azelaic acid, and sometimes a procedure.

Avoid so-called formula or whitening creams sold without a prescription. Many contain strong steroids, hydroquinone or mercury, which can thin the skin, cause rashes and leave darker, lasting marks. If a cream has made your skin thin, red or burning, see a dermatologist rather than stopping it suddenly on your own.

Chaiyan (melasma) chehre par bhoore ya halke kaale dhabbe hote hain, aksar galon, maathe, naak aur hoont ke upar. Inki sab se badi wajah dhoop aur hormones hain, is liye hamal (pregnancy) ya birth control goliyon ke baad aksar nikal aati hain.

Ilaj ka pehla qadam roz sunscreen (SPF 30 ya zyada) hai, har roz, baadal hon tab bhi. Subah vitamin C serum, raat ko niacinamide wali cream aur halka brightening face wash dhabbon ko aahista aahista halka karte hain. Do se teen mahine mein farq nazar aata hai.

Formula ya whitening creams se bachein; in mein aksar steroid ya mercury hota hai jo skin ko patla aur dhabbon ko aur gehra kar deta hai. Gehri ya phailti chaiyan ke liye dermatologist ko dikhayein.

American Academy of Dermatology, "Melasma: Diagnosis and treatment": https://www.aad.org/public/diseases/a-z/melasma-treatment

American Academy of Dermatology, "Melasma: Causes": https://www.aad.org/public/diseases/a-z/melasma-causes

DermNet, "Melasma (facial pigmentation)": https://dermnetnz.org/topics/melasma