Last reviewed: 21 Apr 2022
Last updated: 22 Feb 2018
Summary
Definition
History and exam
Key diagnostic factors
- centrofacial, malar, or mandibular distribution of muddy brown to gray hyperpigmentation
More key diagnostic factors
Risk factors
- female sex
- Fitzpatrick III-VI skin types
- UV radiation
- oral contraceptive pill
- pregnancy
- FHx of melasma
- photosensitizing drugs
More risk factors
Diagnostic investigations
1st investigations to order
- Wood lamp examination
More 1st investigations to order
Investigations to consider
- skin biopsy
More investigations to consider
Emerging tests
- reflectance confocal microscopy (RCM)
Treatment algorithm
ACUTE
pregnant
nonpregnant
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
- Postinflammatory hyperpigmentation
- Phototoxic reaction
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