Summary
Definition
History and exam
Key diagnostic factors
- centrofacial, malar, or mandibular distribution of muddy brown to grey hyperpigmentation
Risk factors
- female sex
- Fitzpatrick III to VI skin types
- UV radiation
- oral contraceptive pill
- pregnancy
- FHx of melasma
- photosensitising drugs
Diagnostic investigations
1st investigations to order
- Wood lamp examination
Investigations to consider
- skin biopsy
Emerging tests
- reflectance confocal microscopy (RCM)
Treatment algorithm
pregnant
non-pregnant
Contributors
Authors
Laura Korb Ferris, MD, PhD, FAAD

Assistant Professor of Dermatology
University of Pittsburgh
Pittsburgh
PA
Disclosures
LKF declares that she has no competing interests.
Maria Liliana Marino, MD
Fellow
Department of Dermatology
Memorial Sloan Kettering Cancer Center
New York
NY
Disclosures
MLM declares that she has no competing interests.
Peer reviewers
Chad M. Hivnor, Major, USAF, MC, FS
Chief
Outpatient & Pediatric Dermatology
59th Medical Wing/ SGOMD
Lackland Air Force Base
San Antonio
TX
Disclosures
CMH declares that he has no competing interests.
Jashin Wu, MD
Chief Dermatology Resident
University of California
Irvine
CA
Disclosures
JW declares that he has no competing interests.
Differentials
- Exogenous ochronosis
- Post-inflammatory hyperpigmentation
- Phototoxic reaction
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