Result of pregnancy, OC use: melasma misconceptions may impede treatment.(Clinical Rounds)

PHOENIX, ARIZ. -- Although melasma may be considered medically benign, the condition can be psychologically malignant, and practitioners need to take action in identifying and treating the condition in order to decrease patient anxiety, Dr. A. Paul Kelly said at a clinical dermatology conference sponsored by Medicis.

Even though the condition occurs in as many as 50%-70% of pregnant women in the United States, misunderstandings may explain why it's mainly dermatologists--and rarely ob.gyns.--who are called upon to treat the condition.

"Only about 2% of ob.gyns. typically treat melasma," said Dr. Kelly, chief of the division of dermatology at Martin Luther King/Charles R. Drew Medical Center in Los Angeles.

"Some women report being told the condition is simply a 'souvenir of being pregnant,' that they can just cover it up with makeup, or that nothing can be done," he said.

In addition to pregnancy, in which melasma typically occurs in the second or third trimester, the condition can also result from oral contraceptive use, and it is more common and distressing in Fitzpatrick skin types III and IV.

Etiology factors for melasma include genetic factors and sun exposure, and clinical patterns include centrofacial (63%), malar (21%), and mandibular (16%).

The condition can take a freckle-like pattern. "The freckle-like pattern usually is not described in textbooks, but it will typically look like patients are developing freckles. You won't see a confluent lesion, but small macules that become confluent," said Dr. Kelly.