Summary
Definition
History and exam
Key diagnostic factors
- centrofacial, malar, or mandibular distribution of muddy brown to gray hyperpigmentation
Risk factors
- female sex
- Fitzpatrick III-VI skin types
- ultraviolet radiation
- oral contraceptive pill
- pregnancy
- family history of melasma
- photosensitizing drugs
Diagnostic tests
1st tests to order
- Wood lamp examination
Tests to consider
- skin biopsy
Emerging tests
- reflectance confocal microscopy (RCM)
Treatment algorithm
pregnant
nonpregnant
Contributors
Authors
Nazanin Saedi, MD
Director
Laser Surgery and Cosmetic Dermatology
Thomas Jefferson University Hospitals
Philadelphia
PA
Disclosures
NZ has been on the advisory board of Cynosure, Cartessa, Allergan, and Alastin; used equipment from Cynosure and Cartessa; and been a consultant to Allergan and Alastin.
Acknowledgements
Dr Nazanin Saedi would like to gratefully acknowledge Dr Laura Korb Ferris and Dr Maria Liliana Marino, previous contributors to this topic.
Disclosures
MLM and LKF declare that they have 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
- Postinflammatory hyperpigmentation
- Phototoxic reaction
More Differentials
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