BEYOND PIGMENTATION: A LONGITUDINAL CASE REPORT OF FACIAL MELASMA AT DR BATRA’S

Abstract

Background: Melasma is a common acquired hyperpigmentary disorder predominantly affecting the face. Its clinical course may be influenced by ultraviolet exposure, hormonal factors and individual susceptibility. Acne and menstrual irregularity may coexist and complicate management.

Case Presentation: A 40-year-old female homemaker presented with pigmentation over both cheeks and forehead for approximately three years. There was no itching. She reported recurrent acne, particularly around the premenstrual period, and had previously developed acne after using an unidentified topical product. Initially, she was not using sunscreen. Her menstrual history was notable for an episode of amenorrhea lasting approximately three months, followed by initially regular cycles and later intermittent menstrual irregularity. Investigations in April 2026 showed Hb 11.2 g/dL, vitamin D 19.51, ferritin 9, TSH 2.95 and HbA1c 5.1%. During follow-up, facial pigmentation was documented as reduced, with only mild tanning noted in May 2026.

Conclusion: This case demonstrates a fluctuating course of facial pigmentation associated with recurrent acne and menstrual irregularity, with documented periods of clinical improvement during longitudinal follow-up. The case also emphasizes the importance of sun protection, hormonal/menstrual assessment and correction of documented nutritional deficiencies. Because objective pigmentation scoring and histopathological assessment were not performed, the clinical outcome should be interpreted cautiously.