Melasma

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Last reviewed: March 2019

Last updated: February 2018

Summary

A harmless pigmentary disorder, seen primarily on the malar region of women with darker skin.

Aetiological factors include hormonal and UV light exposure.

Treatment is with topical retinoids, bleaching agents, chemical peels, and laser or light therapy.

Sun protection is important for maintaining the effects of treatment.

Definition

Melasma is an acquired pigmentary disorder of sun-exposed areas. [1] Characteristically, patients have muddy brown macules on the skin, predominantly in the malar and central facial areas; however, it can also affect areas such as the forearms and neck. This is due to an increase in melanocyte activity and melanin deposition in the skin. Sunlight and hormonal influence are important factors in disease aetiology. [2]

History and exam

Key diagnostic factors

centrofacial, malar, or mandibular distribution of muddy brown to grey hyperpigmentation

Full details

Risk factors

female sex
Fitzpatrick III to VI skin types
UV radiation
oral contraceptive pill
pregnancy
FHx of melasma
photosensitising drugs

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Diagnostic investigations

1st investigations to order

Wood lamp examination

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Investigations to consider

skin biopsy

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Emerging tests

reflectance confocal microscopy (RCM)

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Treatment algorithm

ACUTE

pregnant

non-pregnant

Contributors

Authors VIEW ALL 

Laura Korb Ferris, MD, PhD, FAAD

Laura Korb Ferris

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 VIEW ALL 

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.

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