A 36 Year Old Woman with Hyperpigmented Macules on Face

Abstract

Acquired pigmentary disorders are a common presentation in a dermatology clinic. A middle aged woman presented with brown patches on cheeks, forehead and nose. Woods lamp examination showed accentuation of brown pigmentation. Dermoscopy revealed pseudoreticular network of brown pigment with sparing of perifollicular areas. Based on these features diagnosis of melasma was made. Melasma is one of the most common acquired hyperpigmentation disorder characterized by hyperpigmented macules with irregular margin distributing symmetrically mainly on the face. Sun exposure and hormones are considered as the most important triggering factors. Common differential diagnoses are post-inflammatory hyperpigmentation, riehl’s melanosis and exogenous ochronosis, and lichen planus pigmentosus etc. Apart from distinct clinical features and history of various causes of hyperpigmentation, wood’s lamp examination, dermoscopy, reflectance confocal microscopy as well as histopathology aid in their correct differentiation. Different treatment options for melasma include topical depigmenting agents like hydroquinone, retinoids, kojic acid, arbutin, oral tranexamic acid, chemical peels, intense pulse light, Q-switched Nd-YAG laser and fractional lasers. Selection of therapy depends on patient’s disease severity and associated benefits and risks of various treatments.