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Clinical Summary

Melasma is commonly seen on the face of young adult females. It consists of symmetric, well-defined, light to dark brown patches. The most common sites are on the malar cheek, lateral forehead, upper cutaneous lip, and mandible. Factors associated with accentuation of melasma include sunlight exposure, pregnancy (often called “the mask of pregnancy”), and oral contraceptives.

Management and Disposition

Most patients will be concerned about accentuation of their previously imperceptible melasma. Rule out pregnancy in new-onset or worsening melasma. Essential to any treatment is strict sun avoidance. Refer patients to a dermatologist for further treatment options.


  1. Melasma is common in young females with darker skin types, but all races can be afflicted.

  2. Sun exposure on other parts of the body can cause accentuation of facial melasma.

  3. Contrasted with the hyperpigmentation of melasma, Addison disease is diffuse hyperpigmentation with accentuation in sun-exposed areas.

FIGURE 13.130

Melasma. Well-demarcated, hyperpigmented patch seen on the cheek. (Photo contributor: J. Matthew Hardin, MD.)

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