Most pigment changes in the skin can be attributed to two major factors: hormonal shifts (pregnancy and the use of oral contraceptives are likely culprits) and prolonged exposure to the sun. An old injury, a disease, or an incorrectly administered cosmetic procedure can also contribute to this uneven accumulation of skin pigment in the form of postinflammatory hyperpigmentation. When the cause is hormonal, the pigmentation is called melasma, and it shows up as irregularly shaped blotches, usually on the cheeks, forehead, and upper lip. Melasma is a very common condition but, unfortunately, one of the most difficult to eliminate completely. A few lucky patients might see it go away on its own.
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