Differential Diagnosis of Melasma in Brown Skin

Evangeline B. Handog and Maria Juliet Enriquez-Macarayo

Postinflammatory Hyperpigmentation (PIH)

Postinflammatory hyperpigmentation (Fig. 9.1) presents as asymptomatic hyperpigmented macules and patches ranging in color from either tan to dark brown (epidermal melanin) or gray-blue to gray-brown (dermal melanin) caused by numerous preceding cutaneous insults such as drug and phototoxic reactions, infections, physical injury or trauma, allergic reactions and inflammatory diseases [1].

PIH can occur at any age with no gender preference. Epidermal PIH can result from acne, insect bites, pyodermas, atopic dermatitis, psoriasis and pityriasis rosea. It generally resolves over time, although fading may require months or years in darkly pigmented individuals [2].

On the other hand, dermal PIH has been associated with dermatoses characterized by degeneration of the basal layer of the epidermis and inflammation at the dermal-epidermal junction such as lupus erythematosus and fixed drug eruptions. Resolution is slower and longer than epidermal PIH, and treatment is a challenge.

E.B. Handog (*)

Department of Dermatology, Asian Hospital and Medical Center,

2205 Civic Drive, Alabang, Muntinlupa City, Philippines, 1780 e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

M.J. Enriquez-Macarayo

Department of Dermatology, Angeles University Foundation Medical Center, Pampanga, Philippines

© 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_9

Fig. 9.1 Postinflammatory hyperpigmented patches in an elderly Filipino female with dermatomyositis (Courtesy of the Research Institute for Tropical Medicine, Philippines)

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