Daroach Manju, Vinay Keshavamurthy, Bishnoi Anuradha, Parsad Davinder, Kumaran Muthu Sendhil
Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian Dermatol Online J. 2022 Jun 24;13(4):484-486. doi: 10.4103/idoj.idoj_463_21. eCollection 2022 Jul-Aug.
Extrafacial melasma is a rare presentation, commonly occurring in postmenopausal women with a poor etiological insight and nature of its course. We planned to decipher the natural course of extrafacial melasma based on history questionnaire.
Patients with diagnosis of extrafacial melasma were recruited. After informed consent, complete history including age of onset, duration, progression, sites of involvement (initial site as well as current site of pigmentation), treatment history, history of drug intake, family history, associated other diseases, and clinical photography and dermoscopy were done.
Fifteen extrafacial melasma patients were recruited. All were females with mean age of 51.2 years. History of facial melasma in past was given by 93% of recruited patients. Mean total duration of melasma was 23 years. Ten (66%) patients had centrofacial melasma to begin with, 4 (26%) patients had malar melasma, and 1 (6.6%) had extrafacial melasma as initial presentation. Currently all patients had extrafacial melasma. Mean time for clearance of central face melasma was 18.2 years and appearance of melasma at extrafacial sites was 20 years.
We infer that different clinical patterns of melasma occur sequentially over the natural course of disease and centrofacial melasma as the initial presentation in majority of our patients, progressed to involve extrafacial sites with time.
面部外黄褐斑是一种罕见的表现形式，常见于绝经后女性，其病因及病程性质尚不明确。我们计划通过病史问卷来解读面部外黄褐斑的自然病程。
招募被诊断为面部外黄褐斑的患者。在获得知情同意后，记录完整病史，包括发病年龄、病程、进展情况、受累部位（色素沉着的初始部位及当前部位）、治疗史、用药史、家族史、相关其他疾病，并进行临床拍照和皮肤镜检查。
招募了15例面部外黄褐斑患者。均为女性，平均年龄51.2岁。93%的招募患者有既往面部黄褐斑病史。黄褐斑的平均总病程为23年。10例（66%）患者最初为面部中央型黄褐斑，4例（26%）患者为颧部黄褐斑，1例（6.6%）患者最初表现为面部外黄褐斑。目前所有患者均为面部外黄褐斑。面部中央黄褐斑消退的平均时间为18.2年，面部外部位出现黄褐斑的时间为20年。
我们推断，在疾病的自然病程中，黄褐斑的不同临床模式依次出现，并且在我们的大多数患者中，面部中央型黄褐斑作为初始表现，随着时间推移逐渐发展至累及面部外部位。
