Melasma Workup

  • Author: Andrew D Montemarano, DO; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 14, 2012
 

Laboratory Studies

Usually, no laboratory tests are indicated for melasma. 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.[7]

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Histologic Findings

Melanin is increased in the epidermis, in the dermis, or (most commonly) in both locations in melasma patients. 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.

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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, American Society for Dermatologic Surgery, and MedChi

Disclosure: Nothing to disclose.

Coauthor(s)

Hugh Lyford  Surgical Technician, The Skin Cancer Surgery Center

Disclosure: Nothing to disclose.

Specialty Editor Board

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Pandya AG, Hynan LS, Bhore R, et al. Reliability assessment and validation of the Melasma Area and Severity Index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. Apr 14 2010;[Medline].

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

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

  4. Adalatkhah H, Sadeghi-bazargani H, Amini-sani N, Zeynizadeh S. Melasma and its association with different types of nevi in women: a case-control study. BMC Dermatol. Aug 5 2008;8:3. [Medline].

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

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

  7. 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].

  8. Kodali S, Guevara IL, Carrigan CR, Daulat S, Blanco G, Boker A, et al. A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women. J Am Acad Dermatol. Dec 2010;63(6):1030-5. [Medline].

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

  10. 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].

  11. 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].

  12. Jeong SY, Shin JB, Yeo UC, Kim WS, Kim IH. Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser for Melasma with Pre- or Post-Treatment Triple Combination Cream. Dermatol Surg. Apr 1 2010;[Medline].

  13. Draelos ZD. Commentary: Low-Fluence Q-Switched Neodymium-Doped Yttrium Aluminum Garnet Laser for Melasma with Pre- or Post-Treatment Triple Combination Cream. Dermatol Surg. Apr 1 2010;[Medline].

  14. Kroon MW, Wind BS, Beek JF, van der Veen JP, Nieuweboer-Krobotová L, Bos JD, et al. Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled pilot study. J Am Acad Dermatol. Mar 2011;64(3):516-23. [Medline].

  15. Salem A, Gamil H, Ramadan A, Harras M, Amer A. Melasma: treatment evaluation. J Cosmet Laser Ther. Sep 2009;11(3):146-50. [Medline].

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

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

  18. Kimbrough-Green CK, Griffiths CE, Finkel LJ, 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].

  19. 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].

  20. Chan R, Park KC, Lee MH, et al. A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%) compared with hydroquinone 4% cream in Asian patients with moderate to severe melasma. Br J Dermatol. Sep 2008;159(3):697-703. [Medline].

  21. Grimes PE, Bhawan J, Guevara IL, et al. Continuous therapy followed by a maintenance therapy regimen with a triple combination cream for melasma. J Am Acad Dermatol. Apr 14 2010;[Medline].

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

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

  24. 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].

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

  26. Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, et al. Treatment of Melasma With Oral Administration of Tranexamic Acid. Aesthetic Plast Surg. May 3 2012;[Medline].

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

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

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

  30. 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].

  31. 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].

  32. Perez M, Sanchez JL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol. Dec 1983;81(6):543-5. [Medline].

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

  34. 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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Confluent hyperpigmented macules in a malar distribution.
Melasma in a man.
 
 
 
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