Melasma
Alerts and Notices
Synopsis
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.
Codes
ICD10CM:L81.1 – Chloasma
SNOMEDCT:
36209000 – Melasma
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Post-inflammatory pigmentation from acne, eczema, superficial injuries
- Drug-induced hyperpigmentation from medications such as tetracyclines, phenothiazines, minocycline, and amiodarone (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
- Riehl melanosis
- Facial erythema ab igne (seen in silversmiths, jewelers, bakers, chefs)
- Lentigo
- Lentigo maligna
- Lentigo maligna melanoma
- Erythema dyschromicum perstans
- Addison disease
- Fixed drug eruption
- Use of mercury-containing creams
Best Tests
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Management Pearls
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Therapy
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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.Subscription Required
References
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Last Reviewed:07/10/2017
Last Updated:06/09/2019
Last Updated:06/09/2019
Patient Information for Melasma
Overview
Melasma is a common disorder of unknown cause that causes dark (hyperpigmented) patches, primarily on the face. The condition is marked by brown patches that worsen in response to increases of the hormone estrogen, such as during pregnancy or with the use of birth control pills. Other medications, such as anti-seizure medications, may also cause melasma. Increased sun exposure can also be a cause.Who’s At Risk
- Although the condition is more common in women, men can also have melasma.
- People with darker skin are generally more likely to have it.
- Family history increases likelihood of developing melasma.
Signs & Symptoms
The dark patches of melasma most commonly affect the face, particularly the sides (lateral portions) of the cheeks and sometimes the skin above the lips.Self-Care Guidelines
- Protect your skin from sun exposure to prevent worsening, and use a combined UVB+UVA sunscreen.
- Use sunscreen year-round, since the skin is very sensitive to even small amounts of ultraviolet (UV) light.
- With your doctor's permission, stop using medications that may be causing your melasma.
When to Seek Medical Care
Melasma is a benign condition that does not require treatment, but if it becomes bothersome, see your doctor.Treatments
- Use bleaching agents (hydroquinone 4%) carefully. Do not apply these agents to the normally pigmented surrounding skin, as normal skin may also be bleached. Use hydroquinone under the supervision of a physician, as side effects, such as darkening of the skin, may occur.
- Hydroquinone is often irritating and may require the use of 1% hydrocortisone cream, which may also help with the hyperpigmentation. Combination therapy with tretinoin cream may also be helpful.
- Superficial chemical peels (application of an acid to remove the top layers of the skin) and microdermabrasion (a facial sanding technique) may offer additional help.
- A topical agent, azelaic acid, may be helpful.
- Laser therapy has not yet been shown to be satisfactory treatment. Melasma may return and hyperpigmentation may develop in the treated area.
References
Bolognia, Jean L., ed. Dermatology, pp.975-976. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.868-869, 1316, 2507. New York: McGraw-Hill, 2003.
Melasma