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
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Melasma