Clinical and Dermoscopic Evaluation of Melasma: A Study of Patterns, Severity, and Associated Risk Factors
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Melasma is a common acquired hyperpigmentary disorder characterised by symmetrical brown macules and patches affecting mainly sun-exposed facial areas. It predominantly occurs in women of reproductive age and is strongly associated with ultraviolet radiation, hormonal influences, pregnancy, oral contraceptive use, and genetic predisposition. Dermoscopy has emerged as an important non-invasive diagnostic tool for evaluating pigment depth, vascular changes, and prognostic features. This study aimed to evaluate the clinical and dermoscopic characteristics of melasma, assess disease severity using the Melasma Area and Severity Index (MASI), and determine the association between dermoscopic findings and major clinical risk factors. This study included 80 patients with clinically diagnosed facial melasma attending the dermatology outpatient clinic. Demographic and clinical data were collected, including age, sex, skin phototype, family history, oral contraceptive use, topical steroid use, sun exposure, and pregnancy-related melasma. Clinical classification was based on facial distribution patterns. Dermoscopic examination was performed using a handheld dermoscope with ×10 magnification. MASI scoring was used to assess severity. The mean age was 34.5 ± 5.2 years, and females represented 95.0% of cases. Malar melasma was the predominant clinical pattern (72.5%). Brown background pigmentation (90.0%), irregular pigment network (87.5%), and brown globules and dots (97.5%) were the most frequent dermoscopic findings. Telangiectasia was present in 77.5% of patients. Sun exposure showed a significant association with telangiectasia (OR = 4.67; 95% CI: 1.28–16.99; p = 0.023). Dermoscopy provides valuable diagnostic and prognostic information in melasma and supports individualised management strategies.
[1] A. C. Handel, L. D. B. Miot, and H. A. Miot, “Melasma: A Clinical and Epidemiological Review,” An. Bras. Dermatol., vol. 89, no. 5, pp. 771–782, 2014.
[2] T. Passeron and M. Picardo, “Melasma, a Photoaging Disorder,” Pigment Cell Melanoma Res., vol. 31, no. 4, pp. 461–465, 2018.
[3] R. Sarkar, P. Arora, and K. V. Garg, “Cosmeceuticals for Hyperpigmentation: What Is Available?,” J. Cutan. Aesthet. Surg., vol. 6, no. 1, pp. 4–11, 2013.
[4] O. A. Ogbechie-Godec and N. Elbuluk, “Melasma: An Up-to-Date Comprehensive Review,” Dermatol. Ther. (Heidelb)., vol. 7, no. 3, pp. 305–318, 2017.
[5] N. C. Sathe and M. Launico, “Melasma,” in StatPearls. Treasure Island, FL, USA: StatPearls Publishing, 2026.
[6] M. Rodrigues and A. G. Pandya, “Melasma: Clinical Diagnosis and Management Options,” Australas. J. Dermatol., vol. 56, no. 3, pp. 151–163, 2015.
[7] A. G. Pandya 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., vol. 64, no. 1, pp. 78–83, 2011.
[8] S. Neema and M. Chatterjee, “Dermoscopy in Melasma,” Pigment Int., vol. 3, no. 1, pp. 8–13, 2016.
[9] R. Kumar, A. Das, and D. Pandhi, “Dermoscopic Features of Melasma and Their Correlation with Wood’s Lamp Findings,” Indian Dermatol. Online J., vol. 10, no. 2, pp. 172–178, 2019.
[10] A. C. C. Espósito, G. Brianezi, N. P. de Souza, and H. A. Miot, “Exploratory Study of Individual Characteristics of Melasma in Brazilian Women,” Int. J. Dermatol., vol. 54, no. 8, pp. e265–e266, 2015.
[11] A. Achar and S. K. Rathi, “Melasma: A Clinico-Epidemiological Study of 312 Cases,” Indian J. Dermatol., vol. 56, no. 4, pp. 380–382, 2011.
[12] P. E. Grimes, “Melasma: Etiologic and Therapeutic Considerations,” Arch. Dermatol., vol. 131, no. 12, pp. 1453–1457, 1995.
[13] V. M. Sheth and A. G. Pandya, “Melasma: A Comprehensive Update: Part I,” J. Am. Acad. Dermatol., vol. 65, no. 4, pp. 689–697, 2011.
[14] C. K. Kimbrough-Green et al., “Topical Retinoic Acid (Tretinoin) for Melasma in Black Patients,” Arch. Dermatol., vol. 130, no. 6, pp. 727–733, 1994.
[15] E. H. Kim, Y. C. Kim, E. S. Lee, and H. Y. Kang, “The Vascular Characteristics of Melasma,” J. Dermatol. Sci., vol. 46, no. 2, pp. 111–116, 2007.
[16] A. Coondoo, M. Phiske, S. Verma, and K. Lahiri, “Side-Effects of Topical Steroids: A Long Overdue Revisit,” Indian Dermatol. Online J., vol. 5, no. 4, pp. 416–425, 2014.
[17] K. Shankar et al., “Evidence-Based Treatment for Melasma: Expert Opinion and a Review,” Dermatol. Ther. (Heidelb)., vol. 4, no. 2, pp. 165–186, 2014.
[18] T. Passeron, “Melasma Pathogenesis and Influencing Factors—An Overview of the Latest Research,” J. Eur. Acad. Dermatol. Venereol., vol. 27, suppl. 1, pp. 5–6, 2013.
[19] D. Steiner, C. Feola, N. Bialeski, and F. A. M. Silva, “Treatment of Melasma: Review and Update. Part II,” Surg. Cosmet. Dermatol., vol. 1, no. 3, pp. 114–122, 2009.
