Melasma
Also called chloasma, mask of pregnancy
Acquired symmetric hyperpigmentation of the face, cheeks, forehead, upper lip, driven by UV, oestrogen (pregnancy, hormonal contraception), and genetic predisposition.
Medium skin tone: the patches read light to mid brown against the surrounding skin
How it looks
Symmetric, reticulated hyperpigmented patches over the malar cheeks and forehead with irregular but sharply defined borders and no surface change.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Most prevalent in medium-deep skin tones (Fitzpatrick III–V); rigorous photoprotection is the foundation of every treatment plan.
Symptoms & course
- Asymptomatic
- Darkens with sun exposure
Diagnostic approach
- Clinical; Wood lamp may help estimate depth
- Review hormonal contributors
Differential, and how to separate them
- Vitiligo
Favours it: Loss of pigment, not gain
Against it: Opposite direction of pigment change
Management principles
- Broad-spectrum tinted (iron-oxide) sunscreen daily, non-negotiable
- Topical triple therapy (hydroquinone-based) courses
- Manage expectations: chronic and relapsing with UV
Clinical pearl: Visible light drives melasma too, which is why tinted iron-oxide sunscreen outperforms clear SPF.
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