Although the etiology remains unknown, many factors have been implied as causative agents:

■ Idiopathic

■ Genetic predisposition

■ Oral contraceptives

■ Ovaric disfunctions (elevated levels of LH, FSH and estradiol)

■ Thyroid disfunctions

■ Antiseizure drugs (phenytoin)

■ Cosmetics containing perfumes

Among these factors, sun exposure remains the most important, although all of them significantly increase the activity of tyrosinase in producing melanin.

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