• Melasma is more common in women; in India, men are also frequently affected.
• The main causative factors are sun-exposure and family history. Mustard oil application could also contribute to this condition.
• Pigmented cosmetic dermatitis and cosmetic contact sensitivity: Possibly considered in etiologic factors of melasma; especially in nonpregnancy/lactation-induced melasma or when not associated with hormone therapy.
• May warrant caution regarding over-the-counter (OTC) cosmetic products usage, especially if melasma is recalcitrant.
• This aspect of disease is also important in choosing therapy, as health-related quality of life (HRQoL) can help guide treatment decisions, compare effectiveness of various treatment options and to monitor the disease after treatment is completed.

Practice sutra: As treating physicians, we must not only evaluate, treat and monitor the physical findings of melasma, but we should also determine the impact that melasma has on the HRQoL of an individual.