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Chapter 34: Melasma

INTRODUCTION

KEY POINTS

  • Melasma occurs more commonly in women and though it can occur in all skin colors it is more common in those darker skin tones.

  • Facial melasma has three distributions that include centrofacial, malar, and mandibular. Extrafacial melasma can also occur less commonly on non-facial sites.

  • Melasma can vary in distribution and severity, with color ranging from tan to dark brown.

image

FIGURE 34-1.

Tan to dark-brown patches with central areas of sparing located on the forehead, cheeks, and chin of a young White woman. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 137-13.)

A photo shows brown patches on the forehead, cheeks, and chin.
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FIGURE 34-2.

Large, diffuse, tan-brown symmetric patches with areas of subtle background erythema more densely located on the cheeks, upper cutaneous lip, and chin, along with lateral forehead involvement, in a young woman with light skin. (Reproduced with permission from Tannous Z, Avram MM, Tsao S, et al. Color Atlas of Cosmetic Dermatology, 2nd ed. New York, NY: McGraw Hill; 2011, Figure 5-1.)

A photo shows brown patches with slight redness on the background skin predominantly on the cheek, upper lip, and chin and sparsely on the nose and forehead.
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FIGURE 34-3.

Medium-brown macules and patches symmetrically located on the cheeks, along with the forehead and chin, of a Latin American man. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 51-5.)

A patient with light brown skin exhibits hyperpigmented brown patches and macules across the face. The majority are located on the lateral cheeks.
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FIGURE 34-4.

Prominent, medium-brown reticulated patches on the central forehead, cheeks, and perioral skin of a woman of color. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 51-4.)

A patient with brown skin exhibits dark brown patches on the cheeks, forehead and the region around the mouth.
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FIGURE 34-5.

Dark-brown patches with irregular borders in a centrofacial pattern in a Black man. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 51-3.)

A patient with brown skin exhibits hyperpigmented dark brown, reticulated patches on the nose, medial cheeks and medial forehead.
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FIGURE 34-6.

Tan, ill-defined, reticulated symmetric patches along the lateral cheeks of a Hispanic woman, with sparing of the mid-cheek region. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 51-2.)

A patient with hyperpigmented pale brown, reticulated patches on the cheeks with sparing of the mid medial cheeks.
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FIGURE 34-7.

Medium- to dark-brown patches and streaks with irregular borders on the forehead (including eyebrows), cheeks, upper cutaneous lip, and chin of a woman of color. (Reproduced with permission from Taylor SC, ...

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