Skin nontumor

Pigmentary disorders


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Last staff update: 26 April 2023

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PubMed Search: Melasma skin

Christopher S. Hale, M.D.
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Cite this page: Hale CS. Melasma. website. Accessed September 21st, 2023.
Definition / general
  • Acquired large areas of darkened skin, usually due to hormonal changes (birth control pills, pregnancy) and usually on both sides of face (eMedicine)
  • Clinical patterns are centrofacial, malar and mandibular
  • Classification (based on level of increased melanin in skin determined by Wood's light examination, J Am Acad Dermatol 1981;4:698):
    • Epidermal: 70% of cases, increased melanin in basal and suprabasal epidermis; skin pigmentation enhanced under Wood's light; responds best to bleaching agents
    • Dermal: 10% of cases, increase in melanophages in upper dermis; no enhancement of skin pigmentation under Wood's light, responds poorly to bleaching agents
    • Mixed: 20% of cases, mixture of epidermal and dermal features; patchy enhancement of skin pigmentation under Wood's light
    • Indeterminate: 2% of cases; not possible to characterize pigmentation pattern
  • Also called chloasma
Clinical features
  • 90% women; more common in dark skinned individuals
  • In pregnant women, hormones cause "mask of pregnancy" on face and darkened skin on abdomen and elsewhere
  • Associated with freckles, lentigines and 4+ nevi (BMC Dermatol 2008;8:3)
  • Some cases associated with phenytoin, autoimmune thyroid disease, UV light in men (J Am Acad Dermatol 2012;66:642)
  • May be due to increase in stem cell factor and c-kit expression (Br J Dermatol 2006;154:1094)
Clinical images

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Confluent hyperpigmented macules in a malar distribution

Microscopic (histologic) description
  • Mild lymphohistiocytic infiltrate in 75%
  • Increase in epidermal melanin but no increase in number of melanocytes
  • Melanocytes are larger with prominent dendrites (Am J Dermatopathol 2005;27:96)
Electron microscopy description
  • More melanosomes in keratinocytes, melanocytes and dendrites
Differential diagnosis
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