Melasma in men: a clinical, aetiological and histological study

Melasma, a facial hypermelanosis, is more common in women. In Indians, men seem to be frequently involved. There are hardly any studies delineating the clinical, aetiological and histological features of melasma in men and the present study was taken up to fill this lacuna.A total of 200 patients with melasma were screened for only men having melasma. Data including duration, illnesses, sunlight exposure, use of cosmetics, oil or medication, familial pigmentation, nutritional, parasitic infestations, infections, hepatic disorders, occupation were taken followed by general physical, cutaneous and Woods light examination. Laboratory investigations including skin biopsy were performed.Of 200 patients screened, 41 (20.5%) were men. Their ages ranged from 19 to 53 years. Twenty-four (58.5%) of the patients were outdoor workers. Twelve (29.3%) originally belonged to hilly regions. Clinical patterns were malar in 61%, centrofacial in 29.3% and mandibular in 9.7%. The aetiological factors identified were: sun-exposure in 20 (48.8%), mustard oil usage in 18 (43.9%), family history in 16 (37%), chronic illnesses in five (12.2%) and phenytoin in three (7.3%); of these sun-exposure and family history were statistically significant when compared with those for women. Laboratory investigations revealed anaemia in five (12.2%), giardiasis in two (4.9%), increased leuteinizing hormone (LH) and low testosterone in four (9.7%) men. Skin biopsies in 20 (48.8%) patients revealed features of epidermal melasma in 10 (50%) and a mixed type in nine (45%) patients.Melasma is frequently observed in Indian men. The main causative factors among the male patients appeared to be sun-exposure and family history. Melasma in men is definitely less common than in women, but shares the same clinicohistopathological characteristics as in women.