Aetiology

Melasma occurs most commonly during pregnancy, and has also been associated with the use of oral contraceptives containing oestrogens and/or progestogens, and with certain drugs such as hydantoin.6-8 Sun exposure appears to be important for the development of melasma9 and there also appears to be a familial predisposition.9 Melasma may also affect men, especially those of Hispanic or Asian origin. A descriptive study in 27 men in Puerto Rico suggested that sunlight exposure and family history are the most important determinants for development of melasma in men.10 The cause of melasma is unknown; hormonal mechanisms may be involved. Mild ovarian dysfunction has been considered as a cause after a study found increased levels of leutinising hormone and low levels of serum oestradiol in nine women with melasma.11 A case-control study of 108 non-pregnant women with melasma found a significant association with increased thyroid antibodies in the blood.12 Studies measuring levels of immunoreactive p-melanocyte stimulating hormone found normal levels in patients taking oral contraceptives, some of whom had melasma,13 suggesting that the development of melasma is not related to melanocytic hormone.

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