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Clinical Presentation
The diagnosis of melasma is based on its clinical characteristics.
Physical Examination
The patient presents with well-demarcated tan to brown macular
hyperpigmentation. The pigment may also have a bluish appearance.
Melasma_Initial AssesmentScreening
The severity of melasma may be measured using the Melasma Area and
Severity Index (MASI) or modified MASI (mMASI). The MASI score is calculated
using the area involved, the amount of pigmentation and the severity of melasma
based on the darkness and homogeneity of the pigmentation. The areas involved,
such as the forehead (F), right malar region (MR) and left malar region (LR)
are given the weight of 30% each, while the chin (C) is 10%. The amount of
pigmentation in the four areas is graded in numerical value based on
involvement.
| Amount of Pigmentation | |
| 0 | No involvement |
| 1 | <10% |
| 2 | 10-29% |
| 3 | 30-49% |
| 4 | 50-69% |
| 5 | 70-89% |
| 6 | 90-100% |
The severity is graded on a scale based on the darkness of melasma (D)
compared to normal skin and homogeneity (H) of hyperpigmentation.
| Darkness of Melasma (D) | Homogeneity of Hyperpigmentation (H) | ||
| 0 | Absent | 0 | Absent |
| 1 | Slight | 1 | Slight |
| 2 | Mild | 2 | Mild |
| 3 | Marked | 3 | Marked |
| 4 | Maximum | 4 | Maximum |
The formula to obtain the MASI score is 0.3 (DF + HF) AF + 0.3 (DMR + HMR) AMR + 0.3 (DML + HML) AML + 0.1 (DC + HC) AC. The MASI score range is 0-48. In the mMASI, homogeneity is excluded from the grading of severity and score range is 0-24.