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Beth G Goldstein, MD
Adam O Goldstein, MD, MPH
Valerie D Callender, MD, FAAD
Section Editor
Robert P Dellavalle, MD, PhD, MSPH
Deputy Editor
Rosamaria Corona, MD, DSc


Melasma is an acquired hyperpigmentation of the skin that typically affects the sun-exposed areas of the face. It is most common in women with darker complexions who live in areas of intense ultraviolet (UV) radiation exposure [1]. Melasma causes considerable cosmetic disfigurement and psychologic distress; quality-of-life studies have shown a significant negative effect of melasma on emotional wellbeing, social life, and leisure activities [2-4].

This topic review will discuss the pathogenesis, clinical features, diagnosis, and treatment of melasma.


The prevalence of melasma is unknown. Studies from Mexico and Peru found that melasma accounted for 4 to 10 percent of new dermatology hospital referrals [5,6]. It is more common in women than in men and is rare before puberty, occurring most frequently in women of reproductive age. Melasma occurs during pregnancy in approximately 25 percent of cases [7]. Among pregnant women, the prevalence of melasma ranges between 15 and 50 percent [8,9].


The pathogenesis of melasma is poorly understood. Contributing factors include darker skin phototype (especially III and IV), ultraviolet (UV) radiation, hormonal factors (eg, pregnancy, oral contraceptives), genetic predisposition, cosmetic use, thyroid dysfunction, and antiepileptic medications [1,10-14].

The key role of exposure to UV radiation in the development of melasma is supported by the distribution pattern of facial hyperpigmentation, which spares relatively sun-protected sites such as the philtrum. UV radiation induces melanocyte proliferation and migration and melanogenesis; it also increases the levels of alpha-melanocyte-stimulating hormone and adrenocorticotropic hormone, which in turn upregulate melanocyte proliferation and melanogenesis. In patients with darker skin, visible light also may have a role in increasing skin pigmentation. In a study involving 20 volunteers with skin type IV to VI, both visible light and long-wavelength UVA (UVA1, 340 to 400 nm) were able to induce immediate pigmentation, but the pigmentation was more intense and more stable after visible light exposure than after UVA exposure [15].

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Literature review current through: Sep 2017. | This topic last updated: Jun 13, 2017.
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