Melasma is an acquired hypermelanosis involving sun-exposed skin. The main concern to the patient is its cosmetic effect, especially in young women.


Clinical features:

(1) It involves sun-exposed skin, typically on the face (rarely on the hands and forearms).

(2) It may be exacerbated by sunlight and UV-A or UV-B lights, so tends to be seen during the summer months.

(3) It is more often in women than men. In women it is more common during child-bearing years.

(4) It is more common in Hispanics and Asians.


Facial patterns:

(1) centrofacial (cheeks, forehead, upper lip, nose and chin)

(2) malar (cheeks and nose)

(3) mandibular pattern (ramus of the mandible)


Precipitating factors:

(1) in women, pregnancy or use of oral contraceptive agents

(2) drug-associated (phenytoin or methylphenytoin)

(3) endocrine dysfunction

(4) liver dysfunction

(5) nutritional deficiencies

(6) idiopathic


The differential diagnosis includes:

(1) post-inflammatory hyperpigmentation.

(2) SLE (if a malar pattern)



(1) sunblocking creams

(2) bleach

(3) time

(4) if possible, change in precipitating cause (stopping medications; treating underlying disease; it may reverse after delivery if associated with pregnancy)


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