Can you get melasma on your body?

Melasma is generally considered to be a problem of pigmentation on the face. No one knows exactly why or how melasma happens though this is an active area of research. Is it possible to get melasma on non-facial skin? #askdrnatalia

It is really very rare but ‘extrafacial melasma’ – the term used to describe melasma on the body – has been reported in the scientific literature. Madke et al (2016) reported the case of a 55-year-old woman with symmetrical patches of brown pigmentation on the skin of bother her forearms, which had been present for about 6 years. After ruling out all other possible causes for this and doing skin biopsies, she was diagnosed with extrafacial melasma. Patients with melasma make up a large part of my clinical practice and even then I see extrafacial melasma very rarely.

A few weeks back I had a patient come to me with what I would consider a ‘textbook’ example. There have been a few case series published over the past 20 years describing this condition as well as comparing the histology of facial to extrafacial melasma. Though they are similar, extrafacial melasma tends to occur exclusively in peri- or post-menopausal women, though a direct link with HRT has not been established. These patients also have a genetic predisposition to pigmentation problems, for example having facial melasma at a younger age.