Association of sun exposure, hormonal factors, and cosmetic use with melasma: An observational study in urban Indian women.

Abstract

Background:
Melasma is a common acquired hypermelanosis characterized by irregular brown macules, predominantly affecting women with darker skin types.

Objectives:

To evaluate the association of sun exposure, hormonal factors, and cosmetic use with the clinical patterns and severity of melasma among urban Indian women.

Methods:

A cross-sectional observational study was conducted among 100 women clinically diagnosed with melasma attending a tertiary dermatology outpatient clinic in urban India. Data on demographic profile, duration of sun exposure, hormonal history (pregnancy, oral contraceptive use), and cosmetic usage were collected using a structured questionnaire. Clinical evaluation included pattern classification and severity assessment using the Modified Melasma Area and Severity Index (mMASI). Statistical significance of associations was analyzed using the chi-square test, with p < 0.05 considered significant.

Results:

The mean age of participants was 34.8 ± 6.7 years, with the majority in the 30–40-year group (58%). The malar pattern (52%) was most frequent, followed by centrofacial (38%) and mandibular (10%) types. Moderate-to-severe melasma was noted in 54% of women. Significant associations were found with sun exposure >2 hours/day (p < 0.01), hormonal influences including pregnancy and OCP use (p = 0.02), and regular cosmetic use (p = 0.03). Family history of melasma was observed in 34% of participants, predominantly among those with Fitzpatrick skin type IV.

Conclusion:

Melasma among Indian women shows a clear association with prolonged sun exposure, hormonal influences, and regular cosmetic use. The predominance of malar and centrofacial patterns, particularly in women with Fitzpatrick skin type IV, highlights the combined impact of environmental triggers and genetic predisposition.

Recommendations:

Dermatologists should incorporate counseling on UV protection, screening for hormonal triggers, and guidance on safe cosmetic practices into routine management protocols for melasma. Longitudinal studies are recommended to assess the long-term impact of behavioral modification and hormonal regulation on melasma recurrence.