Brief Answer:
Sun protection I most important

Detailed Answer:
Hello.
Welcome to Healthcaremagic.com.

I have read your query. I understand your concern.
Melasma is a very common condition of skin usually in females. Various predisposing factors for the melasma are genetic , sun exposure, thyroid dysfunction, anemia, hormonal changes, use of oral contraceptive pills and few medications like Phenytoin.

I would advise you to get following investigations :
1) Hemoglobin
2) Serum Ferritin levels
3) Thyroid profile

If no reason is found, then it is considered as idiopathic in origin.
If any underlying cause if found, treatment is given to correct the same.
The most important thing is to avoid sun exposure by using broad spectrum sunscreen regularly over all the exposed areas.
I prefer to advise Kligman' s formulation that is a combination of hydroquinone, tretinoin and flucinolone acetonide to apply on pigmentation in night time only. It should not be used beyond 2-3 weeks without doctors advice.
Afterwards maintenance therapy started .
Melasma can be kept under control by medications but it has very high tendency of relapse if treatment is stopped completely.

I hope it helps.
Take care.

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Brief Answer:
it may be one of the reasons

Detailed Answer:
Hello. Welcome back. It may be the reason. She should take iron supplements to improve the hemoglobin levels.
Take care.

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