Classification and Clinical Presentations of Melasma in Brown Skin

Filomena Legarda-Montinola


The color tone of brown (brown racial classification) is predominantly seen among Asians, Latinos, Latin Americans, American Indians, Middle Eastern population, Mediterranean-Africans, and South African population. Melanin deciphers the skin color of the skin. There are various interracial tones of brown skin. The density of the melanocytes and their location, activity, and function are an important focus in the study and treatment of melasma. Every effort is directed to improve methods to locate that specific melanocyte as well as investigate the many factors that may influence its activity. This unique interplay of location, number, and activity may vary from one skin type to another. The typical brown skin tone patient affected with melasma is usually from Fitzpatrick skin types III, IV, and V, sometimes VI. Factors such as sun exposure and hormones are known triggers exacerbating this condition. Equally important are the genetic and hormonal factors in combination with UV radiation [1]. A study of 324 patients in nine centers globally showed significant relationship with a positive family history of at least one relative with melasma, 97 % of which were first-degree relatives [2-4].

The classification of melasma has been categorized by different methods. Clinical presentation, in reference to the anatomical location of the hyperpigmentation, is the most commonly used classification method. Another is by grading the severity of melasma as mild, moderate, and severe. This is a quick glance simple terminology serving more as a rapid descriptive assessment in reference to the overall clinical picture. Classification can also be done using aids such as Wood’s light, histopathology, dermoscopy, and confocal microscopy. The Melasma Area and

F. Legarda-Montinola

Asian Hospital and Medical Center, Muntinlupa, Philippines e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer India 2017

E.B. Handog, M.J. Enriquez-Macarayo (eds.), Melasma and Vitiligo in Brown Skin, DOI 10.1007/978-81-322-3664-1_5

Severity Index (MASI) score and the Melasma Quality of Life Scale (MELASQol) are additional objective and subjective classification methods useful in research and treatment protocols [2]. These are all discussed in the succeeding chapters.

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