although it can affect any one , it is more common in women , especially pregnant women and those who are taking contraceptives or hormone replacement therapy .
melasma is thought to be the stimulation of melanocytes to produce more melanin pigments when there is sun exposure .
melasma symptoms are dark , irregular well demarcated hyper pigmented macules to patches commonly found on the upper cheek , nose , lips and forehead .
when the skin is exposed to the sun the hyperpigmentation becomes darker which shows the effect of sun exposure in melasma pathophysiology .
it 's most common presentation is cirrhosis , hypopituitarism , cardiomyopathy , diabetes , arthritis or hyper pigmentation , which worsens by sun exposure . both melasma and hemochromatosis have hyperpigmentation all over the body , but melasma mostly involves places , which are exposed to the sun more frequently .
melasma is the most common reason of skin hyperpigmentation , which its treatments are often ineffective as it comes back with continued exposure to the sun .
iron , cobalt , magnesium and selenium , vitamin e and c are known to have effect on skin diseases progress , but little data about serum iron level and melasma .
although iron overload affects skin pigmentation , effect of iron deficiency on skin is not clear .
hence , we evaluated serum iron level , ferritin and total iron binding capacity ( tibc ) level among nonpregnant women with and without melasma .
in a cross - sectional case - control study performed in 2012 in university referral dermatologic clinic of rasoul akram and razi hospitals . we included patients who have melisma as a case group .
women with the history of cardiac or thyroid disease and usage of hormone therapy , phototoxic drugs or anti convulsant drugs or pregnancy were not included .
nonpregnant women without melisma were considered as the control group . after declaring sufficient information , a written consent was taken from all participants .
control and case groups were matched for demographic variables ( age , marital status , body mass index and known related melasma disorder ) .
the checklist included three parts to collect data regarding demographic information , medical history , and medical examination .
we also checked serum iron level , tibc and ferritin level of blood in both groups .
we considered serum iron level 55 - 160 g / dl , ferritin 11 - 306 ng / dl and tibc 228 - 428 g / dl as normal amounts among our patients .
data were analyzed by statistical package for the social sciences ( spss ) for windows ( version 16.0 ; chicago , il , usa ) .
means were compared using independent t - test and proportions were compared using chi - square test .
thirty - three nonpregnant women with melasma ( case ) and 33 nonpregnant women without melasm were evaluated during 1-year study .
control and case groups were matched for demographic variables ( age , marital status , body mass index and known related melasma disorder ) .
demographic information compared between case and control groups mean ( standard deviation ) serum iron level , tibc and ferritin is shown in table 2 .
comparison of measured variables among case and control groups in case group , 27% had a lower level of serum iron , and 10% had upper serum iron level . in the control group ,
15% were in the lower level and 10% upper level of serum iron ( p > 0.05 ) .
about 23% of patients in the case group had low ferritin level compared with 12% in the control group , but not statistically significant .
the mean serum iron level in the case group was a lower than the control group .
however , ping et al . found higher amounts of iron , magnesium , copper , and zinc among 46 nonpregnant women with melasma .
however jie et al . showed higher iron and copper in women with melisma comparing with women without melasma .
study with larger sample size may be suggested . in our study , melasma was more observed in the age 25 - 35 years old .
melasma is a common acquired disorder characterized by symmetric , hyperpigmented patches , which are most prevalent among young to middle - aged women .
we did not find any significant difference between case and control groups in tibc and ferritin between two groups .
the prevalence of low iron serum was more in case group ( 27% ) compared with the control group ( 15% ) . in a research conducted in 2012 , 14.3% of patients with melasma also had low serum iron level .
there are different factors that have an effect on melasma . considering the common dermatologic symptoms of iron overload disease ( hemochromatosis ) and the relationship between iron deficiency and melisma .
although the serum iron level was lower in nonpregnant women with mealsma , it was not significant compared with those without melasma . considering iron deficiency anemia as a prevalent problem among young women and as the fact that there are not definite treatments for melasma
furthermore , there is a need for further evaluations with larger sample sizes regarding this issue .
one limitation of our study was that we did not consider family history of melasma in our demographic data among our groups , which are an important predisposing factor .
eb contributed in the conception of the work , conducting the study , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work fb contributed in the conception of the work , conducting the study , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work se contributed in the conception of the work , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work kh contributed in the conception of the work , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work ag contributed in the design of the work , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work zacontributed in the conception of the work , conducting the study , revising the draft , approval of the final version of the manuscript , and agreed for all aspects of the work .
 background : melasma is a common acquired disorder characterized by symmetric , hyperpigmented patches with an irregular outline , occurring most commonly on the face . it is most prevalent among young to middle - aged women . 
 although iron overload affects skin pigmentation , effect of iron deficiency on skin is not clear . 
 so , we evaluated serum iron level , ferritin and total iron binding capacity ( tibc ) level among nonpregnant women with and without melasma.materials and methods : a cross - sectional case study was conducted in 2012 at university dermatologic department on 33 nonpregnant women with melasma ( case ) and 33 nonpregnant women without melasma ( control ) . serum iron level , tibc and ferritin in the two groups was measured and compared.results:serum iron level was lower in the case group ( 85  11 ) in comparison with control group ( 102  9 ) , but the difference was not significant ( p : 0.9 ) . 
 mean tibc and ferritin were higher in the case group ( tibc : 329.4  29 , ferritin : 6  18 ) than the control group ( tibc : 329.3  29 , ferritin : 33  6 ) without significant difference.conclusion:although the serum iron level was lower in nonpregnant women with mealsma , it was not significant compared with those without melasma . 
INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
CONCLUSION
AUTHOR'S CONTRIBUTION