Pigment Disorders: The Daily PANCE Blueprint
A 34-year-old woman presents with symmetric, hyperpigmented patches on her cheeks and forehead that have worsened over the summer. She has no other skin complaints. She is currently using oral contraceptives. What is the most likely diagnosis?
A. Melasma
B. Solar lentigines
C. Vitiligo
D. Post-inflammatory hyperpigmentation
E. Seborrheic keratosis
Answer and topic summary
The answer is A. Melasma
Melasma is characterized by symmetric, hyperpigmented patches, typically on the face. It is more common in women and can be triggered or worsened by sun exposure and hormonal factors, such as the use of oral contraceptives. The distribution and worsening with sun exposure in this patient are classic for melasma.
Incorrect Answers:
B. Solar lentigines – Also known as “sun spots,” these are small, localized, darkened patches on the skin, but they are usually not as symmetrically distributed as melasma.
C. Vitiligo – This condition is characterized by depigmented (white) patches on the skin, not hyperpigmentation.
D. Post-inflammatory hyperpigmentation – This occurs after an inflammatory skin condition (like acne) and typically presents as localized dark spots at the sites of previous inflammation, not the symmetric facial distribution seen in melasma.
E. Seborrheic keratosis – These are benign skin growths that appear as slightly raised, brownish or black lesions, but they do not present as symmetric hyperpigmented patches like melasma.
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