Melasma is an acquired diffuse hypermelanosis characterized by localized, symmetrical, irregular, light-to-dark brown maculae occurring in sun-exposed areas of the skin. Its etiology is multifactorial. Though it is a common skin condition in Greece, epidemiological studies are few and geographically confined. The present study aimed to establish the epidemiological pattern of melasma in patients attending our hospital and to study the variation in demographics, etiological factors and its clinical features. The study evaluated 68 patients with melasma. Mean age was 41 years. Females dominated (96%). Melasma had a peak incidence of onset in the fourth decade with mean age of onset at 36.55 years. In our sample 23.5% had skin type II, 56% had skin type III and 20.5% had skin type IV. Nearly 53% of the study population gave a definite exacerbation due to sun exposure. Among the 64 female patients, risk factors were associated with pregnancy (36%) and use of combined oral contraceptives (23%).Use of cosmetics was found in nine patients (14%).  There appeared to be a genetic predisposition evident as a definite family history was present in 33% of the patients. On clinical examination, 28% of patients showed a malar type of distribution of lesion while centrofacial type was noticed in 53% and mandibular type in 10% of patients. Extrafacial melasma was seen in 9% of patients. Subjects had a 22% and 31% incidence of thyroid abnormalities and abnormal serum vitamin D respectively. Amongst our patients, there were 9 patients who had abnormal values for estrogen, 5 patients for progesterone and 3 patients for prolactin. Both environmental and genetic factors play a role in the precipitation and exacerbation of melasma. There is a wide variation in its demography, clinical picture and etiology. It is correlated even with lighter skin phototypes (skin type II). There is an association between thyroid disease and melasma. Our findings may prompt us to further investigate melasma for the presence of vitamin D deficiency.

Clinical and epidemiologic features of melasma: a study from Greece