Skin type

Skin color

Sunburn and tanning history

I

White

Always burns, never tans

II

White

Always burns, tans minimally

III

White

Burns moderately, tans gradually

IV

Olive

Minimal burning, tans well

V

Brown

Rarely burns, tans darkly

VI

Dark brown

Never burns, tans darkly black

a. Melasma

Melasma is an acquired patchy hyperpigmentation predominantly occurring in individuals with Fitzpatrick skin phototypes III and IV. It is a common disorder affecting nearly 5 million people in the U.S. alone. Although most frequently seen in women, 10% of cases occur in men. The reported prevalence ranges from 8.8% of Hispanic women in the Southern U.S. to 40% of Southeast Asian females.³

Melasma occurs primarily in 3 ­clinical patterns: 1.) centrofacial, 2.) ­malar, and 3.) mandibular, although many patients have a mixture of these presentations (Figure 1). The most common is centrofacial and consists of light to dark brown patches occurring on the forehead, cheeks, nose, upper lip, or chin. The malar pattern affects the cheeks and nose, while the mandibular pattern occurs along the jawline.

Figure 1 Melasma

The clinical manifestations of melasma are thought to result from the presence of biologically hyperactive melanocytes in the affected skin. The exact etiology of melasma remains unknown, however, several risk factors have been identified. Affected individuals frequently have a family history suggesting the influence of genetics.

In addition, sun exposure is a common exacerbating factor most likely through upregulation of melanocyte-stimulating factors. The high incidence of melasma in women, especially those who are pregnant or taking oral contraceptives, suggests an important role for estrogen.

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