I have suffered from melasma since my twenties, I am approaching my 47th birthday. It is a devastating condition, but there are much worse things to be diagnosed with. I have taken a positive approach because otherwise you become depressed about it. I have done extensive research and have seen many dermatologists regarding melasma. I was wearing the highest SPF and a hat while in the sun and the melasma was getting darker. I found out through my research that most dermatologists do not know that individuals with melasma need to wear a physical barrier sunscreen. ZINC OXIDE. Look on the sunscreen label and make sure it has a high percentage of zinc oxide in it. Also, titanium dioxide. Those two ingredients only. No chemical sunscreens. I was using a sunscreen with SPF 100 and the dermatologist looked at my face and rudely told me that I have to use sunscreen. When I told her that I was using sunscreen with the highest SPF, she told me that I wasn't and gave me free samples of a chemical barrier sunscreen. It hurt and I cried, that's when I went home and did my own research on sunscreens. I found out that I can't go out on a hot, sunny day. If you get overheated it will make the melasma darker. I go out early in the morning or at dusk to do any outdoor activities. I wear a physical barrier sunscreen every single day. If I am on vacation, I wear a wide brimmed hat with SPF and two different kinds of physical barrier sunscreens and sit in the shade. I treat my skin gently, no lasers, no chemical peels, etc. because the melasma comes back. Save your money, you are just giving it away. Those are expensive temporary fixes. My whole family suffers from this, my sister has laser treatments and chemical peels all year long to keep it faded, but she has the money. As soon as she goes outside it comes right back. I use a BB cream with zinc and titanium dioxide in it and then I use Dermablend foundation (also has zinc and titanium in it) and also a coverup cream that is waterproof. You need to use layers of sunscreen and you can not get overheated. It can be depressing on vacation because you can't just jump in the water and go snorkeling. Also, even with a hat and sunscreen you can not go in the pool for an extended amount of time because the reflection off of the water makes the melasma darker. Oh and the reflection off of metal bleachers at a ballgame makes it worse as well. The one positive of having melasma is that I look young for my age because my face has not seen the sun in 15 years. I do not see a dermatologist or anything. No botox, etc. The dermatologists that I did see for the melasma when it first developed told me that they wouldn't do laser because it looked like it would make my skin worse. My skin will get a dark spot from a little pimple. Any inflammation whatsoever will create a permanent dark mark on my face. It's like all the inflammation that I ever had shows on my skin. I consider this melasma an autoimmune disease like vitiligo. Through my research, I learned that melasma acts just like autoimmune skin conditions. That's why I am really strict on "NO SUN". I take Vitamin D for that reason. My melasma has faded a little over the years, but not much. If I take a hot shower, it gets darker. I have learned to accept this condition. I just wish that doctors would do some research on this and find a cure. My brother even has melasma now. It's weird, my mom and dad do not suffer from melasma at all but all four of their children do! All four of us have severe melasma. I say severe because it never fades in the winter and our whole faces are affected with dark black melasma. We are the first generation to suffer from melasma. I say suffer because my whole face is affected and now I have it on my arms, chest and legs (from driving in the car). I will need to start putting zinc oxide all over now, not just on my face. My melasma will get darker if I'm sitting in my house with no sunscreen on. You can not be in any sunlight. My sisters and I joke around about it because we are seriously living like vampires! Both of my kids developed melasma now. They are 27 (girl) and 20 (boy). My daughter gets it all over her back and started getting it above her lip (she doesn't take any birth control and never has) and my son's melasma showed up this year and it is all over his back and abdomen. I religiously put sunscreen on them as children because they have fair skin. They also played travel softball and baseball, so the areas where they are getting the melasma was covered all summer long! The heat really brings it out in them. We went on vacation and they golfed every day and it was hot. So they were sweating and I am not talking about a little patch, their whole backs and my son's abdomen is affected with huge dark areas. I am starting to think that a gene has mutated in our DNA that is causing melasma in most of our family members. I am the oldest so I developed melasma first and my family didn't understand what the big deal was until they all started getting it. Heat and sunlight are the triggers for us. Because we were told that hormones cause the melasma none of us use birth control with hormones and we still have melasma. I also have cousins that started developing melasma but it doesn't seem to be as severe as ours. I will not see another dermatologist about melasma because they do not get it! That is the most frustrating thing about having melasma, people not understanding it. Doctors are not doing enough research and they are just blowing it off like a hormonal, sun condition that you just have to deal with. Stop seeing dermatologists for melasma, they do not know enough about it and you just become depressed with every visit. You need to accept this condition, do everything you can to prevent it and look at the positive. No wrinkles!