Melasma is a harmless pigmentary disorder, seen primarily on the malar region of women with darker skin.
Etiologic factors include hormonal and ultraviolet 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.
Melasma is an acquired pigmentary disorder of sun-exposed areas. 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 etiology.
History and exam
Key diagnostic factors
- centrofacial, malar, or mandibular distribution of muddy brown to gray hyperpigmentation
- female sex
- Fitzpatrick III-VI skin types
- ultraviolet radiation
- oral contraceptive pill
- family history of melasma
- photosensitizing drugs
1st investigations to order
- Wood lamp examination
Investigations to consider
- skin biopsy
- reflectance confocal microscopy (RCM)
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