A clinical and dermatoscopic study of melasma

Abstract

Melasma is an acquired hypermelanosis that occurs exclusively in sun-exposed area mostly on face and rarely on the neck and forearms. It is more common in women and in Asians. Exact pathogenesis remains elusive, however, genetic predisposition and ultraviolet light exposure seem to play an important role.The aim of this study was to evaluate facial melasma clinically and dermatoscopically and to compare the consistency of the findings with respect to each type of melasma. Dermatoscopy is increasingly being used for diagnosis of pigmentary disorders other than malignancy. Hospital based cross sectional descriptive study. Study was conducted in the Dermatology department of Yenepoya Medical College and Hospital on 110 patients during the period of December 2016 to June 2018.Clinical examination includes standard dermatological examination along with Wood’s lamp and dermatoscopic examination (Detailed format attached).Heine Delta 20 plus Dermatoscope was used for evaluation of the lesions.: A total of 110 patients with clinical diagnosis of melasma attending the Department of dermatology in Yenepoya medical college were studied during a period of 18 months. Maximum number of patients (35.5%) belonged to the age group between 31 and 40 years. Study showed a female preponderance (69.1%) . On the basis of Fitzpatrick skin type, patients with Type IV (90%). With respect to occupation housewives (60%) and manual labourers /farmers (25.5%) formed the majority indicating chronic sunexposure to be a leading cause for melasma. Patients having Centrofacial pattern predominated with 59.1% of the total. In 43.6% of the women cycles were regular, 5.45% had irregular cycles and 20.9% of the women had attained menopause. We found that 66.4% of the patients had a moderate MASI score. Under Wood’s lamp examination patchy enhancement was seen in 56.4% of the patients indicating a mixed pattern. Among the various patterns observed reticuloglobular pattern dominated our study with 85.45% of patients being positive for the pattern. In our study patients presented with some additional features under dermatoscopy namely telangiectasia (36.1%), followed by depigmentation (24.5%). On the basis of dermatoscopy, 64.5% predominantly showed an epidermal pattern.Dermoscopy serves as useful tool in assessing the type of melasma based on the MASI score.