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Last reviewed: 19 Sep 2025
Last updated: 11 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • centrofacial, malar, or mandibular distribution of muddy brown to grey hyperpigmentation
Full details

Risk factors

  • female sex
  • Fitzpatrick III to VI skin types
  • ultraviolet radiation
  • oral contraceptive pill
  • pregnancy
  • family history of melasma
  • photosensitising drugs
Full details

Diagnostic investigations

1st investigations to order

  • Wood lamp examination
Full details

Investigations to consider

  • skin biopsy
Full details

Emerging tests

  • reflectance confocal microscopy (RCM)
Full details

Treatment algorithm

ACUTE

pregnant

non-pregnant

Contributors

Authors

Nazanin Saedi, MD

Director

Laser Surgery and Cosmetic Dermatology

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

NZ has been on the advisory board of Cynosure, Cartessa, Allergan, and Alastin; used equipment from Cynosure and Cartessa; and been a consultant to Allergan and Alastin.

Acknowledgements

Dr Nazanin Saedi would like to gratefully acknowledge Dr Laura Korb Ferris and Dr Maria Liliana Marino, previous contributors to this topic.

Disclosures

MLM and LKF declare that they have no competing interests.

Peer reviewers

Chad M. Hivnor, Major, USAF, MC, FS

Chief

Outpatient & Pediatric Dermatology

59th Medical Wing/ SGOMD

Lackland Air Force Base

San Antonio

TX

Disclosures

CMH declares that he has no competing interests.

Jashin Wu, MD

Chief Dermatology Resident

University of California

Irvine

CA

Disclosures

JW declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Ball Arefiev KL, Hantash BM. Advances in the treatment of melasma: a review of the recent literature. Dermatol Surg. 2012 Jul;38(7 Pt 1):971-84. Abstract

Rajaratnam R, Halpern J, Salim A, et al. Interventions for melasma. Cochrane Database Syst Rev. 2010;(7):CD003583. Abstract

Kang HY, Ortonne JP. What should be considered in treatment of melasma. Ann Dermatol. 2010 Nov;22(4):373-8.Full text  Abstract

Austin E, Nguyen JK, Jagdeo J. Topical treatments for melasma: a systematic review of randomized controlled trials. J Drugs Dermatol. 2019 Nov 1;18(11):S1545961619P1156X.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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