Melasma - also called chloasma - is a dark skin discoloration found on sun-exposed areas of the face. A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face).

Cause of Melasma
Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk. Melasma is often associated with the female hormones estrogen and progesterone. Melasma is especially common in pregnant women, women who are taking oral contraceptives ("the pill"), and women taking hormone replacement therapy during menopause. Sun exposure is also a strong risk factor for melasma. It is particularly common in tropical climates.

Melasma Symptoms
Melasma doesn't cause any other symptoms besides skin discoloration but may be of great cosmetic concern.

Melasma treatment
Melasma treatment involves sun blocks, bleach, and time. First-line therapy for melasma should consist of fixed triple combinations. Where patients have either sensitivity to the ingredients or a triple combination therapy is unavailable, other compounds with dual ingredients (hydroquinone plus glycolic acid) or single agents (4% hydroquinone, 0.1% retinoic acid, or 20% azelaic acid) may be considered as an alternative. In patients who failed to respond to therapy, options for second-line therapy include peels either alone or in combination with topical therapy. Lasers should rarely be used in the treatment of melasma.
   I am not aware of a melasma cure. A combination of tretinoin cream and a bleaching cream containing hydroquinone may be helpful in fading some types of melasma. Occasionally, chemical peels or topical steroid cream can be helpful. In severe cases, laser treatment for melasma can be used to remove the dark pigment. For temporary help, melasma make up can be used.

Natural Melasma treatment -- Home Remedy for Melasma
The best treatment for melasma may be a combination of topical creams and oral supplements. A new treatment for melasma could include grape seed extract. Another option is topical arbutin.

Melasma Prevention
Daily sunscreen use not only helps prevent melasma, but reduces the risk for wrinkles and skin cancer.

Melasma Research Update
Oral intake of proanthocyanidin-rich extract from grape seeds improves melasma.
Phytother Res. 2004 Nov;18(11):895-9.
Melasma (melasma), an acquired hypermelanosis, is often recalcitrant to various treatments and an amenable, as well as safe, pigment-reducing modality is needed. We investigated that the reducing effect of proanthocyanidins on melasma in a one-year open design study. Proanthocyanidin-rich grape seed extract was orally administered to 12 Japanese woman candidates with melasma for 6 months between August 2001 and January 2002 and to 11 of these 12 for 5 months between March and July 2002. Clinical observation, L* value (lightening) and melanin index, and size (length and width) measurements of melasma were performed throughout the study period. The first 6 months of grape seed extract intake improved or slightly improved melasma in 10 of the 12 women and following 5 months of intake improved or slightly improved melasma in 6 of the 11 candidates. L* values also increased after grape seed extract intake. Melanin-index significantly decreased after 6 months of the intake, and also decreased at the end of study. Grape seed extract is effective in reducing the hyperpigmentation of women with melasma. The beneficial effects of grape seed extract was maximally achieved after 6 months and these was no further improvement after this period. The latter grape seed extract intake for 5 months may prevent melasma from becoming worse prior to the summer season. Grape seed extract is safe and useful for improving melasma.

MSM and melasma
I am not familiar with the use of MSM for melasma. MSM creams are available, however they are most often used for pain relief.

Melasma removal
Melasma microdermabrasion is available and can be performed by a dermatologist.

Melasma treatment questions
Q. Regarding your information on melasma treatment options. Do you not know that hydroquinone has been banned in the UK, Europe, South Africa and parts of Asia for it's toxicity, carcinogenic properties and scarring potential? That it causes melasma to come back much stronger after discontinued use and upon a subsequent courses? The FDA has not banned hydroxyquinone yet, but they will probably be up to speed in the next few years or so.
   A. I will look into this claim in detail before I answer it. If any dermatologists who treat melasma have an opinion regarding this comment, please email me.