Dark patchy pigmentation on the face of women is a medical condition called melasma. Melasma is thought to be caused by a combination of hormones and UV light. It is commonly begins during pregnancy or after starting oral contraceptives but it can occur even without any known cause of excessive hormone. Melasma can be difficult to treat and may require multiple and continual treatment. Treatments include topical lighteners such as hydroquinone (typically prescription,) or non-prescription, non-hydroquinone lighteners (SkinMedica LYTERA® Skin Brightening Complex, SkinCeuticals Discoloration Defense,) chemical peels, and lasers including Clear + Brilliant, Fraxel Dual, Genesis, Qswitch 1064, and RevLite® SI, light based treatments such as intense pulse light (elight SRA). Usually a combination of treatments as well as extremely consistent sun protection with high percentage zinc oxide sunscreens (skinfo® Pure Protection) is necessary to keep melasma at bay.