Pictorial case study: Dark brown macules

This facial discolouration became worse after a holiday. By Dr Jean Watkins.

What’s the diagnosis?

This 43-year-old woman attended the surgery worried about the dark brown macules, with well defined borders, on her cheeks and forehead. She had been aware of the discoloration for some time, but felt it had become dramatically worse since a holiday in Spain. It was a problem she could no longer hide with make-up and friends had noticed it. Her general health was good and the only medication she had been on was the combined oral contraceptive pill.

The answer: Melasma

Melasma is relatively common. It affects more women than men, particularly those with dark skin, subject to sun exposure and with a family history of the problem. Hormones also play a part.

To treat, any aggravating factors should be reduced, an alternative to hormonal contraception found and advice offered regarding sun exposure.

Cosmetic camouflage may help to disguise the blemishes. Depigmenting agents are the mainstay of treatment. A mild topical corticosteroid may help fade the colour and reduce the chance of eczema from use of other agents.

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