Kunjumani Sobhanakumari

Facial hypermelanosis is a clinical feature of a diverse group of disorders most commonly in middle-aged females who are exposed to sunlight. There is a considerable overlap in clinical features among the clinical entities of facial hypermelanosis. Aetiology in most of facial melanosis is unknown, but some factors like UV radiation in melasma and exposure to allergens in Riehl’s melanosis could be implicated. Histopathology is an accurate diagnostic tool. The benefit of histopathology is not only to confirm diagnosis, but also to exclude related disorders. Among the hyperpigmented conditions, melasma, Riehl’s melanosis, Acanthosis Nigricans (AN) and Lichen Planus Pigmentosus (LPP) are the common causes of facial hypermelanosis - most common being melasma.
This is a descriptive cross-sectional study of hundred consenting patients who attended the outpatient wing of Dermatology Department of Government Medical College, Kottayam. They were included only after getting the written informed consent.
Maximum number of patients were in the 5th decade. 65% were females. Homemakers/housewives constituted the main study group (34%).55% of patients had duration of pigmentation between 1 to 5 years. Among these, melasma and acanthosis nigricans had the longest duration of disease. 69% of patients were symptomatic. Most common clinical diagnosis was melasma (45) followed by acanthosis nigricans (17), Riehl’s melanosis (15) and lichen planus pigmentosus (14). One case each of exogenous ochronosis and Addison’s disease and remaining were post inflammatory. Histopathologically, 63% of patients had histological features suggestive of melasma, which evolved as the most common cause of facial melanosis, next common being acanthosis nigricans and Riehl’s melanosis.
Clinical and histopathological examination is must to confirm the definite diagnosis of facial hyper-pigmentation. Skin is said to be the window to systemic diseases. So some of the pigmentation is diagnostic clue for the underlined systemic disorder or disease.