Melasma appears as brown and grey-brown lace-like patches on the cheekbones, forehead, upper lip and sometimes jawline. Rarely, it can also occur on the forearms. Melasma is triggered by estrogen hormones (especially during or following pregnancy, and with oral contraceptive pills) in addition to sun and heat exposure. Pigmentation typically worsens during spring and summer months or during sunny vacations. Many cosmetic treatment options including low-energy laser, chemical peels, and topical creams can be used to improve pigmentation.