• Users Online: 1947
  • Print this page
  • Email this page

  Table of Contents  
Year : 2017  |  Volume : 8  |  Issue : 6  |  Page : 525-526  

Dermoscopy of melasma

1 Consultant Dermatologist and Dermatosurgeon, SKINNOCENCE: The Skin Clinic, Gurgaon, Haryana, India
2 Department of Skin and V.D, Patna Medical College and Hospital, Patna, Bihar, India
3 Department of Dermatology Consultant Dermatologist, Apollo Hospital, Noida, Uttar Pradesh, India

Date of Web Publication14-Nov-2017

Correspondence Address:
Sidharth Sonthalia
C-2246, Sushant Lok-1, Block C, Gurgaon – 122 009, Haryana
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_6_17

Rights and Permissions

How to cite this article:
Sonthalia S, Jha AK, Langar S. Dermoscopy of melasma. Indian Dermatol Online J 2017;8:525-6

How to cite this URL:
Sonthalia S, Jha AK, Langar S. Dermoscopy of melasma. Indian Dermatol Online J [serial online] 2017 [cited 2022 Jan 27];8:525-6. Available from: https://www.idoj.in/text.asp?2017/8/6/525/218348

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

Click here to view
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)

Click here to view
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)

Click here to view

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].[1],[2]
Table 1: Dermoscopic features seen in various pigmentary disorders

Click here to view

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).[1],[2] A light-to-dark brown background and brown granules and globules with perifollicular sparing have been uniformly described.[1],[2],[3],[4],[5] 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


Conflicts of interest

There are no conflicts of interest.

   References Top

Bhattar PA, Zawar VP, Godse KV, Patil SP, Nadkarni NJ, Gautam MM. Exogenous Ochronosis. Indian J Dermatol 2015;60:537-43.  Back to cited text no. 1
[PUBMED]  [Full text]  
Khunger N, Kandhari R. Dermoscopic criteria for differentiating exogenous ochronosis from melasma. Indian J Dermatol Venereol Leprol 2013;79:819-21.  Back to cited text no. 2
[PUBMED]  [Full text]  
Yalamanchili R, Shastry V, Betkerur J. Clinico-epidemiological Study and Quality of Life Assessment in Melasma. Indian J Dermatol 2015;60:519.  Back to cited text no. 3
[PUBMED]  [Full text]  
Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N. Melasma update. Indian Dermatol Online J 2014;5:426-35.  Back to cited text no. 4
  [Full text]  
Barcauí CB, Pereira FBC, Tamler C, Fonseca RMR. Classification of melasma by dermoscopy: Comparative study with Wood's lamp. Surg Cosm Dermatol 2009;1:115-9.  Back to cited text no. 5
Ibrahim ZA, Gheida SF, El Maghraby GM, Farag ZE. Evaluation of the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma. J Cosmet Dermatol 2015;14:113-23.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

This article has been cited by
1 Split-face comparative study between intradermal tranexamic acid injection alone versus intradermal tranexamic acid injection combined with Q-switched Nd:YAG laser in melasma treatment: dermoscopic and clinical evaluation
Soha Abdalla Hawwam, Mayada Ismail, Yasmina Ahmed El-Attar
Lasers in Medical Science. 2022;
[Pubmed] | [DOI]
2 Clinical, dermoscopic, and histopathologic evaluation of vitamin C versus PRP , with microneedling in the treatment of mixed melasma: A split-face, comparative study
Amal T. Abdel-Rahman, Fatma G. Abdel-Hakeem, Maha H. Ragaie
Dermatologic Therapy. 2021;
[Pubmed] | [DOI]
3 Clinical observation and dermoscopy evaluation of fractional CO 2 laser combined with topical tranexamic acid in melasma treatments
Yan Qu, Fengjuan Wang, Junru Liu, Xiujuan Xia
Journal of Cosmetic Dermatology. 2021; 20(4): 1110
[Pubmed] | [DOI]
4 A comparative study of melasma severity after hyperthyroid therapy in hyperthyroid subjects with melasma
Benny Nelson, Irma Bernadette S. Sitohang, Melani Marissa, Wresti Indriatmi, Wismandari Wisnu
Acta Dermatovenerologica Alpina Pannonica et Adriatica. 2021; 30(1)
[Pubmed] | [DOI]
5 Both Age and Disease Duration are Associated with Clinical Phenotype of Hori’s Nevus in Chinese: A Retrospective Analysis of 497 Cases
Yiping Zhong, Lining Huang, Tingting Yan, Yongjun Chen, Bin Yang, Mao-Qiang Man
Clinical, Cosmetic and Investigational Dermatology. 2021; Volume 14: 65
[Pubmed] | [DOI]
6 Efficacy and safety of different low fluences of Q-switched Nd:YAG laser in treatment of melasma: a split-face clinical and dermoscopic comparative study
Manal Bosseila, Noha Ghonim, Pakinam Mostafa
Lasers in Medical Science. 2021;
[Pubmed] | [DOI]
7 Diffuse facial melanosis – An overview of etiology and dermoscopic findings
Bijina Kolukulangara Dharman, Swetha Sridhar
Journal of Skin and Sexually Transmitted Diseases. 2020; 2: 86
[Pubmed] | [DOI]
8 The Vascular Component of Melasma: A Systematic Review of Laboratory, Diagnostic, and Therapeutic Evidence
Natasha Masub, Julie K. Nguyen, Evan Austin, Jared Jagdeo
Dermatologic Surgery. 2020; 46(12): 1642
[Pubmed] | [DOI]
9 New local treatments for different types of melasma: Vascular type vs nonvascular type. A randomized polycentric study
Massimo Fioranelli, Mohammad Jafferany, Uwe Wollina, Michael Tirant, Nguyen Van Thuong, Torello Lotti
Dermatologic Therapy. 2020; 33(3)
[Pubmed] | [DOI]
10 Dermoscopy of Pigmentary Disorders in Brown Skin
Manas Chatterjee,Shekhar Neema
Dermatologic Clinics. 2018; 36(4): 473
[Pubmed] | [DOI]
11 Dermoscopy of lichen planus pigmentosus in Indian patients – Pitfalls to avoid
Sidharth Sonthalia, Enzo Errichetti, Feroze Kaliyadan, AbhijeetKumar Jha, Aimilios Lallas
Indian Journal of Dermatology, Venereology and Leprology. 2018; 84(3): 311
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Article Figures
    Article Tables

 Article Access Statistics
    PDF Downloaded893    
    Comments [Add]    
    Cited by others 11    

Recommend this journal