1.   What is Melasma?

Melasma is derived from Greek word ‘Melas’ meaning black. It is an acquired disorder of symmetrical hyperpigmentation appearing as light brown to dark, muddy brown patches usually on the face, especially in the forehead, cheeks and chin.

 2. Who is more prone to Melasma? Which age group is most affected?

Proneness to melasma varies according to race (Southeast Asian), skin type(darker), sex(F: M=4;1). Middle-aged females are more commonly affected. 

3. Which areas are typically affected?

Areas typically affected are Face, mainly forehead, cheeks, nose, upper lip or chin.

 4. What causes Melasma? What are the triggers?

UV rays are cited to be the most common factor for melasma induction and persistence.
The exact cause is not known but it seems to be multifactorial. Genetic predisposition, hormonal factors and darker skin type are some of the known risk factors. Sun exposure is a commonly reported trigger due to stimulation of melanocytes, the cells producing the pigment melanin. Many patients note the onset or worsening of the disease with pregnancy or oral contraceptive use. Other less commonly reported risk factors include thyroid disorders, phototoxic medications and cosmetics. 

5. What are the different stages?

No stages described

 6. What does Melasma look like on the skin?

Light to dark brown symmetrical patches

 7. What are the signs & symptoms? 

Other than patches, it has no symptoms (like itch, pain etc) 

8. When should a doctor be consulted? The doctor should be consulted at the earliest for better management as this disease negatively impacts your quality of life.

 9. How serious can it get if left untreated?

Can become darker and spread to other areas if protective measures are not used or the triggers not removed. 

10. How is it diagnosed? What is the treatment?

A dermatologist will diagnose it clinically (i.e. by simply examining your skin). Woods lamp may help in assessing the depth. In doubtful cases and to rule out other diagnoses, a biopsy may be needed (very rare). 

11. Are there any OTC products that work? If yes, some of their names.

OTC sunscreens and other lightening creams. However, some of them contain harmful topical steroids which may harm your skin. 

12. What are the other medications and treatment options available?

A dermatologist may prescribe some pigment reducing creams containing one or more of the following: hydroquinone, azelaic acid, retinoids, kojic acid, arbutin, liquorice extract etc. or Tablets too. 

Sunscreens and sun avoidance are necessary. Chemical peels

Chemical skin peels are performed using a chemical solution applied directly to the skin to burn away dead cells and allow the newer, fresher skin to form. 
and Fractional lasers are adjuvants, it is a chronic recalcitrant disorder and nothing cures it. 

13. Are there any home remedies?

Sour milk, turmeric etc are applied for a bleaching effect. Ask them before you do any home remedy if on treatment already from a dermatologist. 

14. What are the Dos & Donts?

Dos: Sun avoidance; Sun protection; Healthy diet (fruits and salads) rich in antioxidants  

Donts: Direct sun exposure; Apply OTC creams containing Topical steroids 

15. How can Melasma be prevented?

As mostly it develops without any cause, it is difficult to prevent it. If there are any clear triggering factors like oral contraceptives, these can be removed.

Reference: Melasma: a comprehensive update: part I. Sheth VM, Pandya AG. J Am Acad Dermatol. 2011 Oct;65(4):689-97; quiz 698. doi: 10.1016/j.jaad.2010.12.046. Review.

In summary, while melasma can be a persistent, frustrating and difficult skin disorder, a comprehensive management approach, including avoidance of sun and irritants, use of sunscreens, depigmenting agents, occasional procedures, and close supervision by your dermatologist can lead to a successful outcome.