eMedicine Specialties > Dermatology > Diseases of Pigmentation

Melasma: Differential Diagnoses & Workup

Author: Andrew D Montemarano, DO, Consulting Staff, The Skin Cancer Surgery Center
Contributor Information and Disclosures

Updated: Jan 9, 2008

Differential Diagnoses

Addison Disease
Drug-Induced Photosensitivity
Lupus Erythematosus, Discoid
Mastocytosis
Poikiloderma of Civatte

Other Problems to Be Considered

Actinic lichen planus3
Linear morphea4

Workup

Laboratory Studies

  • Usually, no laboratory tests are indicated.
  • Consider checking thyroid function test results.
  • Wood light examination usually helps to localize the pigment to the epidermis or the dermis. Note that in many cases, the pigment is found in both locations.

Histologic Findings

Melanin is increased in the epidermis, in the dermis, or (most commonly) in both locations. Epidermal melanin is found in keratinocytes in the basal and suprabasal area. In most cases, the number of melanocytes is not increased, yet the melanocytes that are present are larger, more dendritic, and more active. Dermal melanin is found in the superficial and mid dermis within macrophages, which often congregate around small, dilated vessels. Inflammation is sparse or absent.

More on Melasma

Overview: Melasma
Differential Diagnoses & Workup: Melasma
Treatment & Medication: Melasma
Follow-up: Melasma
Multimedia: Melasma
References
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References

  1. Hughes BR. Melasma occurring in twin sisters. J Am Acad Dermatol. Nov 1987;17(5 Pt 1):841. [Medline].

  2. Resnik S. Melasma induced by oral contraceptive drugs. JAMA. Feb 27 1967;199(9):601-5. [Medline].

  3. Aloi F, Solaroli C, Giovannini E. Actinic lichen planus simulating melasma. Dermatology. 1997;195(1):69-70. [Medline].

  4. Tabata H, Yamakage A, Yamazaki S. Bandlike melasma mimicking linear morphea ("en coup de sabre" type). Cutis. Apr 1998;61(4):225-6. [Medline].

  5. Kopera D, Hohenleutner U. Ruby laser treatment of melasma and postinflammatory hyperpigmentation. Dermatol Surg. Nov 1995;21(11):994. [Medline].

  6. Taylor CR, Anderson RR. Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol. Sep 1994;20(9):592-7. [Medline].

  7. Nouri K, Bowes L, Chartier T, Romagosa R, Spencer J. Combination treatment of melasma with pulsed CO2 laser followed by Q-switched alexandrite laser: a pilot study. Dermatol Surg. Jun 1999;25(6):494-7. [Medline].

  8. Burke H, Carmichael AJ. Reversible melasma associated with tretinoin. Br J Dermatol. Nov 1996;135(5):862. [Medline].

  9. Baliña LM, Graupe K. The treatment of melasma. 20% azelaic acid versus 4% hydroquinone cream. Int J Dermatol. Dec 1991;30(12):893-5. [Medline].

  10. Breathnach AS. Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid, and other therapies. Cutis. Jan 1996;57(1 Suppl):36-45. [Medline].

  11. Garcia A, Fulton JE Jr. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg. May 1996;22(5):443-7. [Medline].

  12. Grimes PE. Melasma. Etiologic and therapeutic considerations. Arch Dermatol. Dec 1995;131(12):1453-7. [Medline].

  13. Grimes PE, Stockton T. Pigmentary disorders in blacks. Dermatol Clin. Apr 1988;6(2):271-81. [Medline].

  14. Hassan I, Kaur I, Sialy R, Dash RJ. Hormonal milieu in the maintenance of melasma in fertile women. J Dermatol. Aug 1998;25(8):510-2. [Medline].

  15. Kang WH, Chun SC, Lee S. Intermittent therapy for melasma in Asian patients with combined topical agents (retinoic acid, hydroquinone and hydrocortisone): clinical and histological studies. J Dermatol. Sep 1998;25(9):587-96. [Medline].

  16. Kanwar AJ, Dhar S, Kaur S. Treatment of melasma with potent topical corticosteroids. Dermatology. 1994;188(2):170. [Medline].

  17. Kimbrough-Green CK, Griffiths CE, Finkel LJ, Hamilton TA, Bulengo-Ransby SM, Ellis CN, et al. Topical retinoic acid (tretinoin) for melasma in black patients. A vehicle-controlled clinical trial. Arch Dermatol. Jun 1994;130(6):727-33. [Medline].

  18. Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol. Apr 1997;36(4):589-93. [Medline].

  19. Ortonne JP, Passeron T. Melanin pigmentary disorders: treatment update. Dermatol Clin. Apr 2005;23(2):209-26. [Medline].

  20. Pathak MA, Fitzpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol. Oct 1986;15(4 Pt 2):894-9. [Medline].

  21. Pérez M, Sánchez JL, Aguiló F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol. Dec 1983;81(6):543-5. [Medline].

  22. Sialy R, Hassan I, Kaur I, Dash RJ. Melasma in men: a hormonal profile. J Dermatol. Jan 2000;27(1):64-5. [Medline].

  23. Wolf R, Wolf D, Tamir A, Politi Y. Melasma: a mask of stress. Br J Dermatol. Aug 1991;125(2):192-3. [Medline].

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Further Reading

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Keywords

chloasma, the mask of pregnancy, hypermelanosis

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Contributor Information and Disclosures

Author

Andrew D Montemarano, DO, Consulting Staff, The Skin Cancer Surgery Center
Andrew D Montemarano, DO is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, and American Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute
James Fulton Jr, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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