Dermoscopy of Melasma.

A 35-year-old lady presented with brown macules of centrofacial melasma within 6 months of child birth. [Figure 1]. She was euthyroid and had never used sunscreens, depigmenting creams (topical steroids/triple combination), or hormonal pills. Polarized videodermoscopy (EScope; Nakoda, ×20) of the cheek lesion revealed a pseudoreticular pigment network, diffuse light-to-dark brown background with sparing of the periappendageal region (follicular and sweat gland openings), brown granules, and globules, including arcuate and annular structures [Figure 2]. In few fields, increased vascularity and telangiectasias were well visualized [Figure 3].

Figure 1

Light-to-dark brown macules of centrofacial melasma over the cheeks, nose, and upper lip area

Figure 2

Dermoscopy of the melasma lesion revealing diffuse light-to-dark brown (white arrow) pseudoreticular network, multiple brown dots, granules and globules (black arrows), arcuate and annular structures (blue arrows), with sparing of the perifollicular region (green arrows), and around the openings of sweat glands (yellow arrows) (polarizing mode, ×20)

Figure 3

Dermoscopy of another melasma lesion revealing, in addition to the features seen in Figure 2, increased vascularity and telangiectasias (black arrows) (polarizing mode, ×20)

Despite being clinically distinct, melasma may be confused with other facial melanoses, including lichen planus pigmentosus, Riehl melanosis, nevus of Ota, nevus spilus, exogenous ochronosis (EO), and pigmentary demarcation lines. Facial biopsy is often refused by patients. Thus, dermoscopy, being noninvasive, is very useful in differentiating melasma from its clinical differentials, especially EO, and may also aid in choosing the appropriate biopsy site in suspected cases [Table 1].[12]

Table 1

Dermoscopic features seen in various pigmentary disorders

The common perception that dermoscopy of melasma has been extensively described in indexed literature seems to be presumptive. Except for the description in the study by Yalamanchili et al.,[3] other dermoscopic features of melasma have mostly been mentioned as a comparison against other facial melanosis (to rule out melasma).[12] A light-to-dark brown background and brown granules and globules with perifollicular sparing have been uniformly described.[12345] The basic pattern may be reticular or pseudoreticular (more common in deeper melasma).[3] The pigment color may suggest the depth of melasma,[4] although this has been contested.[5] Dermoscope is also a valuable tool in the follow-up of melasma treatment.[6] We have further experienced that, on seeing the dermoscopic pictures, the patients become more treatment compliant.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.