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Other Resources UpToDate PubMed


Contributors: Lauren Ko, Stephanie Diamantis MD, Susan Burgin MD
Other Resources UpToDate PubMed


Melasma is an acquired disorder of hyperpigmentation typically affecting sun-exposed areas of the face. The condition is more common in women with darker skin phototypes (including those of Hispanic and Asian descent). Melasma rarely occurs before puberty, with onset most often in the reproductive years. It has also been rarely reported in males.

Melasma is characterized by irregularly bordered, evenly pigmented tan macules on the face. Darker macules may sometimes be seen ("dermal melasma"). Although the pathophysiology of melasma is poorly understood, thyroid autoimmunity, ultraviolet radiation, hyperestrogenism (pregnancy, contraception), genetics, and anti-epileptic medications are known to be contributing factors.


L81.1 – Chloasma

36209000 – Melasma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Postinflammatory hyperpigmentation from acne, eczema, superficial injuries
  • Drug-induced pigmentation from medications such as tetracyclines, phenothiazines, Minocycline drug-induced pigmentation, and Amiodarone drug-induced pigmentation (usually more diffuse and less irregular in morphology compared with melasma)
  • Poikiloderma of Civatte (usually involves neck)
  • Hydroquinone-induced Exogenous ochronosis, also typically seen in darker skin phototypes
  • Acquired dermal melanocytosis
  • Nevus of Ota
  • Erythromelanosis colli et faciei
  • Pigmented contact dermatitis
  • Facial Erythema ab igne (seen in silversmiths, jewelers, bakers, chefs)
  • Lentigo simplex
  • Lentigo maligna
  • Lentigo maligna melanoma
  • Ashy dermatosis
  • Addison disease
  • Fixed drug eruption
  • Use of mercury-containing creams

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:07/10/2017
Last Updated:06/09/2019
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Patient Information for Melasma
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A medical illustration showing key findings of Melasma : Superior lip, Hyperpigmented patches, Cheeks
Clinical image of Melasma - imageId=425827. Click to open in gallery.  caption: 'An evenly pigmented tan patch on the upper cutaneous lip.'
An evenly pigmented tan patch on the upper cutaneous lip.
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