Risk factors for facial melasma in women: a case-control study

Br J Dermatol. 2014 Sep;171(3):588-94. doi: 10.1111/bjd.13059. Epub 2014 Aug 7.


Background: Melasma is a localized chronic acquired hypermelanosis, common in adult women and which has an important impact on their life quality. Its pathology is unknown, despite some recognized triggering factors.

Objective: To evaluate risk factors for developing facial melasma in women.

Methods: This was a case-control study involving adult women with or without facial melasma, paired by age. Variables were grouped into hierarchical levels: personal characteristic data, exposure variables, links to hormonal stimuli and the State-Trait Anxiety Inventory questionnaire, Brazilian version. The data were analysed using conditional multiple logistic regression.

Results: We evaluated 207 patients and 207 controls. The mean age was 38 years. Cases differed from controls for phototype, Amerindian ancestry [odds ratio (OR) 2·59], years of beach or rural residence (OR 1·06), time exposed to sun at work (OR 1·65), time exposed to sun in leisure activities (OR 1·04), antidepressant/anxiolytic use (OR 4·96), menstrual irregularity (OR 3·83), pregnancy history (OR 3·59), years of oral contraceptive use (OR 1·23) and anxiety scores (OR 1·08). A family history of melasma was reported in 61% of cases and 13% of controls (OR 10·40).

Conclusions: Facial melasma is independently associated with elements linked to pigmentation capacity, family ancestry, chronic sun exposure, sexual hormone stimuli, psychotropics and anxiety traits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Anxiety / complications
  • Case-Control Studies
  • Environmental Exposure / adverse effects
  • Facial Dermatoses / etiology*
  • Female
  • Gonadal Steroid Hormones / physiology
  • Humans
  • Melanosis / etiology*
  • Pedigree
  • Psychotropic Drugs / adverse effects
  • Risk Factors
  • Stress, Psychological / complications
  • Sunbathing
  • Sunlight / adverse effects
  • Sunstroke / complications


  • Gonadal Steroid Hormones
  • Psychotropic Drugs