Patient Case: Melasma
A 32-year-old woman presents to a dermatology clinic with irregular dark patches on her cheeks, forehead, and upper lip that have developed gradually over the past six months. She notes that the pigmentation worsens after sun exposure and that she has no associated itching or pain. She denies using any new skincare products but has been taking oral contraceptives for the past year.
Her medical history is unremarkable, with no previous autoimmune diseases or endocrine disorders. On examination, she has symmetric, well-demarcated, brownish patches on her face, sparing the periorbital and perioral areas. A Wood’s lamp examination enhances the pigmentation, confirming epidermal involvement.
Based on the clinical presentation, she is diagnosed with melasma, a common cause of patchy hyperpigmentation often linked to hormonal changes and sun exposure. She is advised to use broad-spectrum sunscreen daily, along with topical hydroquinone to lighten the pigmentation.
- What is the most likely diagnosis in this patient?
a) Melasma
b) Acanthosis nigricans
c) Vitiligo
d) Addison’s disease - Which factor most likely contributed to the development of the patient’s hyperpigmentation?
a) Fungal infection
b) Oral contraceptive use and sun exposure
c) Iron deficiency anemia
d) chronic kidney disease - What is the best initial treatment for this patient?
a) Broad-spectrum sunscreen and topical hydroquinone
b) Systemic corticosteroids
c) Antifungal therapy
d) Laser therapy - What is the main reason for using a Wood’s lamp in this patient?
a) To detect fungal infection
b) To assess the depth of pigmentation
c) To diagnose bacterial infections
d) To confirm an allergic reaction
