Melasma: Presence of Pigmentation at Superciliary Location

Background: Melasma is a frequently encountered hypermelanoses that affects large number of men and women worldwide. Traditionally, three clinical patterns have been described: Malar, Centrofacial, and Mandibular. Involvement of superciliary region has not been described in any of the patterns; however, it is seen in a significant number of patients. Objective: To observe for presence of pigmentation at superciliary regions in patients suffering from melasma. Methods: Patients with previously untreated melasma attending dermatology out-patient department at our hospital were observed for superciliary pigmentation. Short history pertaining to pigmentation and duration was taken. Clinical patterns of melasma and depth of pigmentation (on wood’s lamp) were noted. Precipitating factors were enquired for and noted if present. Results: Total 82 melasma patients were analysed out of which 36 patients (43.90%) were found to have pigmentation at the superciliary region. Potential precipitating factors seen overall were: sun exposure – 18 (21.95%), pregnancy – 13 (15.86%) and oral contraceptive pills – 8 (9.76%). Among 21 patients who had either pregnancy or contraceptive pills as precipitating factors, 16 had superciliary pigmentation. This increased proportion of hormonal precipitating factors (pregnancy and oral contraceptive pills) seen in superciliary subset was statistically significant (44.44% in superciliary subset vs 25.6% overall, p=0.0423). Conclusion: Superciliary pigmentation is seen in a substantial proportion of melasma patients in our setup. Difference in incidence of hormonal precipitating factors (pregnancy, oral contraceptive pills) among patients with superciliary involvement points towards influence of hormonal factors on pigmentation at this site. Also, cultural factors like veil wearing habits of women in this region may influence superciliary pigmentation. Further studies are required to ascertain the significance and mechanisms of pigmentation at this site.