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Routine Dermatology

Mind the Gap atlas

Melasma on Black skin

Key cue: Symmetric dark-brown to slate-grey patches on forehead, cheeks, upper lip. Dermal pigment is less responsive to topical lighteners; daily SPF with iron oxide is the foundation.

Melasma is an acquired symmetric hyperpigmentation of sun-exposed areas, most often affecting women of reproductive age with Fitzpatrick III-VI skin. It is strongly associated with UV exposure, hormonal change (pregnancy, oral contraceptives), and genetics. On Black skin, melasma can have a deeper (dermal) pigmentation component that is less responsive to topical therapy.

What it actually looks like

Textbook says

Textbook: symmetric brown to grey-brown patches on the forehead, temples, cheeks (malar), upper lip, chin. Three patterns: centrofacial, malar, mandibular.

On Black skin

On Black skin the key differences are:

  • Patches are darker brown to slate-grey, sometimes with a bluish-violaceous tint indicating dermal melanin deposition.
  • Dermal melasma (deeper pigment) is more common and responds less well to hydroquinone and other topical lightening agents. Wood's lamp examination can help distinguish epidermal from dermal component: epidermal melasma enhances under Wood's lamp; dermal melasma doesn't.
  • Sun protection is the foundation of treatment, broad-spectrum SPF 30+ with iron oxide (which blocks visible light, not just UV) every day. Black skin is not immune to UV-driven pigmentation, and visible-light protection is particularly important for melasma.
  • First-line prescription: triple combination cream (hydroquinone 4% + tretinoin 0.05% + fluocinolone 0.01%) monitored by a dermatologist. Adjunctive: azelaic acid, kojic acid, tranexamic acid (oral, off-label).
  • Chemical peels and laser carry higher risk of post-inflammatory hyperpigmentation on Black skin, choose a dermatologist experienced with skin of colour, use conservative settings, and progress slowly.

What to look for

  • Symmetric brown or grey-brown patches on sun-exposed face.
  • Gradual onset, often after pregnancy or starting an oral contraceptive.
  • Worse in summer, better in winter.
  • No itching, scaling, or irritation, melasma is purely cosmetic.

When to seek care

Melasma is routine; schedule a dermatology visit. Ask for a skin-of-colour-experienced clinician if possible. Expectations should be realistic: dermal melasma often improves gradually rather than clearing completely, and maintenance therapy is lifelong.

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Common misdiagnosis

Misdiagnosis as post-inflammatory hyperpigmentation or Hori's nevus (acquired bilateral naevus of Ota-like macules, more common in East Asians) is possible. The symmetry, distribution, and gradual hormonal-sun pattern of melasma usually make it obvious.

See it for yourself, curated external imagery

We don't host clinical photos here. The links below go to peer-reviewed or open-access sources (Mind the Gap, DermNet NZ, PubMed Central, and similar). Each opens in a new tab.

References

  • Kwon SH, Hwang YJ, Lee SK, Park KC. Heterogeneous pathology of melasma and its clinical implications. Int J Mol Sci. 2016;17(6):824. PMID: 27240360.
  • Sheth VM, Pandya AG. Melasma: a comprehensive update: part I. J Am Acad Dermatol. 2011;65(4):689-697. PMID: 21920237.
  • Del Bino S, Duval C, Bernerd F. Clinical and biological characterization of skin pigmentation diversity and its consequences on UV impact. Int J Mol Sci. 2018;19(9):2668. PMID: 30205557.

Medical disclaimer

Educational content only. This is not a substitute for in-person evaluation. If you are worried about yourself or someone you love, see a clinician, and if you are concerned about an emergency sign described here, call 911 or your local emergency number. We do not host clinical imagery; the external references are for reader self-education and are not owned by or affiliated with Black Health.

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