Do you have patchy, mottled pigmentation on your face? You’re not alone. Many people have melasma, which is the presence of brown to gray patches on areas of skin exposed to the sun. It’s common everywhere from the forehead to cheeks, to nose and chin, and even the upper lip. According to the American Academy of Dermatology, a whopping 90 percent of sufferers are women. (Because we don’t have enough to deal with already!)What causes melasma?Sun exposure, pregnancy and hormones from birth control pills are the biggest triggers of melasma. In fact, it’s so common among expecting mothers that it’s even nicknamed “the mask of pregnancy.” For some, the melasma resolves itself once pregnancy is over, while for others, it decides to stick around.Ultraviolet (UV) light from the sun is thought to stimulate melanocytes (color-making skin cells) to produce too much color, resulting in the blotches. Since skin of color naturally has more melanocytes, deeper tones experience higher incidence rates of melasma.Exposure to sun rays is why so many people have worsening symptoms during the summer, or have the melasma return again and again in hot temperatures when it has previously faded away. I also feel strongly that even indoor lighting can aggravate melasma in those who are susceptible.How do I prevent melasma?There’s no way around this—you need to use a sunscreen of at least SPF 30 every day, rain or shine, all year long! This will help protect you, no matter what your internal or external aggressors may be. Plus, the benefits are multiple: You’ll prevent melasma as well as lower your risk of skin cancer and decrease the symptoms of aging. It’s a win-win. And if you’ve previously had melasma, staying out of direct sun during peak hours is essential to preventing relapse.What really works to treat melasma?First, understand that melasma is a notoriously stubborn condition that frustrates a lot of women because it’s not simple to just erase. Multiple modalities may be needed to get the bright results you want, and it could take weeks or months of treatment to see improvement. The good news is that brighter skin will eventually come if you have patience.Topical hydroquinone bleaching creams, both by prescription and over-the-counter, can lighten skin. My favorites are MyBody Sledgehammer and prescription Tri-Luma, both of which contain 4 percent hydroquinone. Apply hydroquinone only to the area that you want to lighten, and it will eventually blend into a better or equal match with the rest of your skin.If birth control pills are the cause, stopping use can lessen the darkness—though in my experience, it typically doesn’t go away entirely just by doing that. You’ll need some kind of treatment, too.Chemical peels (like glycolic acid) can help speed cell turnover to fade patches as fresh, new skin emerges faster. And in the board-certified hands of a skilled dermatologist, professional Fraxel laser treatments can bring dramatic results that make many patients very happy. Do your research though, and only go to someone with the right credentials. This is a condition that takes a lot of expertise to safely and effectively treat with a laser.Don’t feel badly about your melasma. With prevention and the right treatment, your future can be brighter!