الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Melasma is an acquired hypermelanosis characterized by more or less symmetrical, irregular light-to-dark-brown macules and patches on sun-exposed area. It is common among dark skinned women (Fitzpatrick skin types (III-V) during their third and fourth decades of life. Due to its frequent facial involvement, the disease has an impact on the quality of life of patients.
The exact causes of melasma are unknown, although some triggering factors are described such as sun exposure, pregnancy, use of oral contraceptives and other hormone replacement therapy. This suggests that the development of melasma is influenced by many factors, and depends on the interaction of environmental and hormonal influences, with susceptible genetic substrate.
Treatment of melasma is challenging because it is often recalcitrant to therapy, especially in the dermal type, and it frequently recurs even after successfully cleared. Several therapeutic modalities are being used to treat melasma, which include numerous topical agents, tranexamic acid, chemical peels, dermabrasion, and a variety of lasers and light-based devices. However, most treatment options had been disappointing with relatively frequent failures, and the term refractory melasma was designated for these cases. The topical treatment with HQ based creams was considered as the gold standard.
Silymarin has been found to have antioxidant properties. It reduces the harmful effects of solar ultraviolet radiation, such as UV-induced oxidative stress, inflammation, immune responses and DNA damage.