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Melasma Diagnosis
Diagnosis
Diagnosis is based on clinical characteristics
Assessment
Woods Lamp Exam
- Used to visually localize the excessive melanin to the epidermis, dermis, or both
Classification
- Epidermal
- Light brown, with enhancement of pigmentation under Wood’s light
- Melanin increase in basal, suprabasal & stratum corneum layers with highly dendritic & pigmented melanocytes
- Epidermal pigment is more amenable to treatment than dermal pigment
- Dermal
- Ashen or bluish-gray, no enhancement of pigmentation under Wood’s light
- Perivascular melanophages on the superficial & deep dermis with less hyperpigmentation in the epidermal layer
- Mixed
- Dark brown, enhancement is seen in some areas only
- Melanin deposition found in epidermis & dermis
- Indeterminate
- Inapparent under Wood’s light
- Melanin deposition found in dermis
Physical Examination
- Patient presents with well-demarcated tan to brown macular hyperpigmentation
- Based on clinical pattern may be classified to:
- Centrofacial is the most common type with macules & patches on the cheek, forehead, upper lip, nose & chin
- Malar appears on cheeks & nose
- Mandibular lesions are over the ramus of the mandible
- Pigment may also have a bluish appearance
- Severity may be measured using the Melasma Area & Severity Index (MASI), which relies on 4 areas involved: forehead, right malar region, left malar region, & chin
- Grades the area involved & degree of pigmentation
