Melasma

QUESTION 47

A 36-year-old woman presents to the dermatology clinic for evaluation of dark patches on her face. She states that she has noticed darkening of the skin on the sides of her cheeks after giving birth to her last child approximately 1 year ago. The area is asymptomatic but distressing to her as it is not going away. She recently started taking an oral contraceptive pill but otherwise notes no new medications. Her family history is notable for multiple autoimmune conditions including Grave’s disease and systemic lupus erythematosus. She does not wear sunscreen routinely. On examination, there are hyperpigmented patches on the lateral cheeks with areas of hypopigmentation and a reticular pattern on the periphery (47).