{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:26:16Z","timestamp":1787775976737,"version":"build-2784847793"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>Facial melanoses (FMs) encompass a diverse group of disorders characterised by altered facial pigmentation, particularly prevalent in individuals with darker skin types, such as the Indian population. While common causes like melasma, post-inflammatory hyperpigmentation, and lichen planus pigmentosus are well documented in the literature, this review emphasises the lesser-known and uncommon causes of FM. These include facial acanthosis nigricans, maturational hyperpigmentation, frictional facial melanosis, and seborrheic melanosis, which are frequently observed in Indian populations but remain underrecognised and understudied. The aetiology of FM is multifactorial, involving genetic predisposition, racial factors, ultraviolet radiation, and exposure to photosensitising chemicals and allergens. Uncommon causes often present unique diagnostic challenges and are frequently misdiagnosed due to their overlapping clinical features. Diagnosis relies on clinical evaluation, supported by Wood\u2019s lamp examination, dermoscopy, and, in some cases, skin biopsy. FM can be classified into brown, blue, or mixed hypermelanosis based on the location and nature of melanin deposition. Management of these uncommon conditions is complex and requires a nuanced approach. Photoprotection remains a cornerstone of therapy, alongside topical depigmenting agents, chemical peels, and laser or light-based interventions. However, the risk of post-inflammatory hyperpigmentation in richly pigmented skin necessitates cautious and individualised treatment strategies. The lack of standardised guidelines for these uncommon causes further complicates management, underscoring the need for tailored therapeutic approaches. This review highlights the clinical significance of recognising and addressing uncommon causes of FM, which significantly impact patients\u2019 quality of life and psychosocial well-being. Enhanced awareness, further research, and the development of evidence-based treatment protocols are essential to improve outcomes for patients with these understudied conditions. By focussing on these uncommon causes, this review aims to fill a critical gap in the literature and provide a comprehensive resource for clinicians managing facial melanoses in skin of colour. Such comprehensive articles are lacking in literature.<\/jats:p>","DOI":"10.4103\/ijd.ijd_159_25","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T13:00:42Z","timestamp":1772715642000},"page":"171-184","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Facial Melanosis: A Comprehensive Review of Uncommon and Common Presentations with Personal Experience"],"prefix":"10.4103","volume":"71","author":[{"given":"Rashmi","family":"Sarkar","sequence":"first","affiliation":[{"name":"From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damini","family":"Verma","sequence":"additional","affiliation":[{"name":"From the Department of Dermatology, Lady Hardinge Medical College, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"R1-20260501","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4103\/0378-6323.84046","article-title":"Facial melanoses:Indian perspective","volume":"77","author":"Khanna","year":"2011","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R2-20260501","doi-asserted-by":"crossref","first-page":"303","DOI":"10.4103\/0019-5154.57602","article-title":"Topical treatment of melasma","volume":"54","author":"Bandyopadhyay","year":"2009","journal-title":"Indian J Dermatol"},{"key":"R3-20260501","doi-asserted-by":"crossref","first-page":"395","DOI":"10.4103\/0378-6323.140290","article-title":"Skin complexion and pigmentary disorders in facial skin of 1204 women in 4 Indian cities","volume":"80","author":"Hourblin","year":"2014","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R4-20260501","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/S0733-8635(18)30141-4","article-title":"Pigmentary problems in the tropics","volume":"12","author":"Dominguez-Soto","year":"1994","journal-title":"Dermatol Clin"},{"key":"R5-20260501","first-page":"4439","article-title":"A clinical, etiological and histopathological study of acquired facial melanosis","volume":"4","author":"Shah","year":"2016","journal-title":"Sch J App Med Sci"},{"key":"R6-20260501","doi-asserted-by":"crossref","first-page":"80","DOI":"10.4103\/pigmentinternational.pigmentinternational_25_23","article-title":"Facial acanthosis nigricans - A narrative review","volume":"10","author":"Sarkar","year":"2023","journal-title":"Pigment Int"},{"key":"R7-20260501","first-page":"591","article-title":"Facial acanthosis nigricans:A morphological marker of metabolic syndrome","volume":"62","author":"Panda","year":"2017","journal-title":"Indian J Dermatol"},{"key":"R8-20260501","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4103\/Pigmentinternational.Pigmentinternational_32_17","article-title":"Maturational hyperpigmentation:Clinico-dermoscopic and histopathological profile of a new cutaneous marker of metabolic syndrome","volume":"5","author":"Sonthalia","year":"2018","journal-title":"Pigment Int"},{"key":"R9-20260501","doi-asserted-by":"crossref","first-page":"e2020046","DOI":"10.5826\/dpc.1002a46","article-title":"Maturational hyperpigmentation:Cutaneous marker of metabolic syndrome","volume":"10","author":"Sonthalia","year":"2020","journal-title":"Dermatol Pract Concept"},{"key":"R10-20260501","first-page":"23","article-title":"Maturational hyperpigmentation:An update","volume":"4","author":"Goyal","year":"2024","journal-title":"Cosmo Derma"},{"key":"R11-20260501","first-page":"350","article-title":"Addisonian pigmentation of tubercular etiology-A case report","volume":"4","author":"Vijayalakshmi","year":"2018","journal-title":"IP Indian J Clin Exp Dermatol"},{"key":"R12-20260501","first-page":"422","article-title":"Addisonian pigmentation-The great mimicker-A review","volume":"69","author":"Verma","year":"2024","journal-title":"Indian J Dermatol"},{"key":"R13-20260501","doi-asserted-by":"crossref","first-page":"e15187","DOI":"10.1111\/dth.15187","article-title":"Addisonian pigmentation responding to vitamin B12:The nails tell the story!","volume":"35","author":"Sharma","year":"2022","journal-title":"Dermatol Ther"},{"key":"R14-20260501","doi-asserted-by":"crossref","first-page":"285","DOI":"10.4103\/0378-6323.203248","article-title":"Seborrheic melanosis:An entity worthy of mention in dermatological literature","volume":"83","author":"Verma","year":"2017","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R15-20260501","first-page":"15","article-title":"Seborrheic melanosis:A unique under-recognized entity in ethnic skin","volume":"15","author":"Vashisht","year":"2022","journal-title":"J Clin Aesthetic Dermatol"},{"key":"R16-20260501","doi-asserted-by":"crossref","first-page":"78","DOI":"10.4103\/CDR.CDR_6_18","article-title":"Facial frictional melanosis in Indian patients:Defining the entity","volume":"3","author":"Mutalik","year":"2019","journal-title":"Clin Dermatol Rev"},{"key":"R17-20260501","doi-asserted-by":"crossref","first-page":"144","DOI":"10.25259\/IJDVL_820_19","article-title":"Pigmented transverse nasal band:A review","volume":"88","author":"Agarwal","year":"2022","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R18-20260501","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1159\/000018330","article-title":"Pigmentary demarcation lines over the face","volume":"200","author":"Malakar","year":"2000","journal-title":"Dermatology"},{"key":"R19-20260501","first-page":"336","article-title":"Pigmentary demarcation lines over the face","volume":"70","author":"Somani","year":"2004","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R20-20260501","first-page":"381","article-title":"Maladie de Civatte","volume":"9","author":"Pierini","year":"1938","journal-title":"Ann Dermatol Syphilol"},{"key":"R21-20260501","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1468-3083.2005.01213.x","article-title":"Poikiloderma of Civatte:A clinical and epidemiological study","volume":"19","author":"Katoulis","year":"2005","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R22-20260501","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4103\/0378-6323.38409","article-title":"Erythromelanosis follicularis faciei et colli:Relationship with keratosis pilaris","volume":"74","author":"Augustine","year":"2008","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R23-20260501","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/S0190-9622(81)70112-9","article-title":"Erythromelanosis follicularis faciei et colli:A case report","volume":"5","author":"Watt","year":"1981","journal-title":"J Am Acad Dermatol"},{"key":"R24-20260501","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/0019-5154.60356","article-title":"Mucocutaneous manifestations of Chikungunya fever","volume":"55","author":"Bandyopadhyay","year":"2010","journal-title":"Indian J Dermatol"},{"key":"R25-20260501","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/0019-5154.53186","article-title":"Cutaneous manifestations in patients suspected of chikungunya disease","volume":"54","author":"Prashant","year":"2009","journal-title":"Indian J Dermatol"},{"key":"R27-20260501","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/pcmr.12232","article-title":"Sun-induced freckling: Ephelides and solar lentigines","volume":"27","author":"Praetorius","year":"2014","journal-title":"Pigment Cell Melanoma Res"},{"key":"R28-20260501","doi-asserted-by":"crossref","first-page":"487","DOI":"10.4103\/0019-5154.190103","article-title":"Skin hyperpigmentation in Indian population: Insights and best practice","volume":"61","author":"Nouveau","year":"2016","journal-title":"Indian J Dermatol"},{"key":"R29-20260501","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1001\/archderm.1995.01690240119022","article-title":"Melasma. Etiologic and therapeutic considerations","volume":"131","author":"Grimes","year":"1995","journal-title":"Arch Dermatol"},{"key":"R30-20260501","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/ijdvl.IJDVL_633_18","article-title":"Future therapies in melasma: What lies ahead?","volume":"86","author":"Sarkar","year":"2020","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R31-20260501","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.det.2007.04.002","article-title":"Pigmentary disorders in the South East","volume":"25","author":"Hann","year":"2007","journal-title":"Dermatol Clin"},{"key":"R32-20260501","doi-asserted-by":"crossref","first-page":"S272","DOI":"10.1016\/j.jaad.2005.12.039","article-title":"Treatment of melasma","volume":"54","author":"Rendon","year":"2006","journal-title":"J Am Acad Dermatol"},{"key":"R34-20260501","first-page":"20","article-title":"Postinflammatory hyperpigmentation: A review of the epidemiology, clinical features, and treatment options in skin of color","volume":"3","author":"Davis","year":"2010","journal-title":"J Clin Aesthetic Dermatol"},{"key":"R35-20260501","doi-asserted-by":"crossref","first-page":"41","DOI":"10.25259\/IJDVL_804_2021","article-title":"A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities","volume":"89","author":"Sarkar","year":"2023","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"R36-20260501","doi-asserted-by":"crossref","first-page":"663","DOI":"10.4103\/idoj.IDOJ_881_20","article-title":"Acquired dermal macular hyperpigmentation: An update","volume":"12","author":"Vinay","year":"2021","journal-title":"Indian Dermatol Online J"},{"key":"R37-20260501","first-page":"43","article-title":"Lichen planus pigmentosus","volume":"149","author":"Bhutani","year":"1974","journal-title":"Dermatology"},{"key":"R38-20260501","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1046\/j.1365-2230.2003.01367.x","article-title":"A study of 124 Indian patients with lichen planus pigmentosus","volume":"28","author":"Kanwar","year":"2003","journal-title":"Clin Exp Dermatol"},{"key":"R39-20260501","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1111\/jdv.15576","article-title":"Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: Results from a patch and photo-patch test study of 108 patients","volume":"33","author":"Bishnoi","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"R40-20260501","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/j.1365-4362.1982.tb00500.x","article-title":"Riehl's melanosis","volume":"21","author":"rorsman","year":"1982","journal-title":"Int J Dermatol"},{"key":"R41-20260501","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S0190-9622(89)80055-6","article-title":"Erythema dyschromicum perstans and lichen planus: Are they related?","volume":"21","author":"Berger","year":"1989","journal-title":"J Am Acad Dermatol"},{"key":"R42-20260501","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/j.1346-8138.1998.tb02495.x","article-title":"Erythema dyschromicum perstans: Report of a new case and critical review of the literature","volume":"25","author":"Combemale","year":"1998","journal-title":"J Dermatol"},{"key":"R43-20260501","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/j.1440-0960.1954.tb01455.x","article-title":"Report on a case of ? Erythrose pribuccale pigmentaire de BROCQ","volume":"2","author":"Belisario","year":"1954","journal-title":"Australas J Dermatol"},{"key":"R44-20260501","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/pigmentinternational.pigmentinternational_14_22","article-title":"Perioral pigmentation","volume":"9","author":"Bhatt","year":"2022","journal-title":"Pigment Int"},{"key":"R45-20260501","doi-asserted-by":"crossref","first-page":"151","DOI":"10.4103\/0019-5154.127675","article-title":"Periorbital hyperpigmentation: A study of its prevalence, common causative factors and its association with personal habits and other disorders","volume":"59","author":"Sheth","year":"2014","journal-title":"Indian J Dermatol"},{"key":"R46-20260501","first-page":"49","article-title":"Periorbital hyperpigmentation: A comprehensive review","volume":"9","author":"Sarkar","year":"2016","journal-title":"J Clin Aesthetic Dermatol"},{"key":"R47-20260501","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.cps.2014.08.007","article-title":"Dark circles: Etiology and management options","volume":"42","author":"Friedmann","year":"2015","journal-title":"Clin Plast Surg"},{"key":"R48-20260501","first-page":"107","article-title":"Nevus fuscoceruleus ophthalmomaxillaris Ota","volume":"46","author":"Tanino","year":"1939","journal-title":"Jpn J Dermatol"},{"key":"R50-20260501","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/S0190-9622(84)80313-8","article-title":"Acquired, bilateral nevus of Ota-like macules","volume":"10","author":"Hori","year":"1984","journal-title":"J Am Acad Dermatol"},{"key":"R51-20260501","doi-asserted-by":"crossref","first-page":"4341","DOI":"10.3390\/jcm12134341","article-title":"Exogenous ochronosis: Characterizing a rare disorder in skin of color","volume":"12","author":"Lazar","year":"2023","journal-title":"J Clin Med"},{"key":"R52-20260501","first-page":"757","article-title":"Granulomatous ochronosis-a cosmetic-induced skin disorder in blacks","volume":"56","author":"Dogliotti","year":"1979","journal-title":"S Afr Med J"},{"key":"R53-20260501","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/2349-5847.135432","article-title":"Exogenous ochronosis in melasma: A study from South India","volume":"1","author":"Kulandaisamy","year":"2014","journal-title":"Pigment Int"},{"key":"R54-20260501","doi-asserted-by":"crossref","DOI":"10.7573\/dic.2021-11-2","article-title":"Dermatology: How to manage facial hyperpigmentation in skin of colour","volume":"11","author":"Moolla","year":"2022","journal-title":"Drugs Context"}],"container-title":["Indian Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_159_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:47:09Z","timestamp":1787773629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_159_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":51,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijd.ijd_159_25","relation":{},"ISSN":["0019-5154","1998-3611"],"issn-type":[{"value":"0019-5154","type":"print"},{"value":"1998-3611","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]},"assertion":[{"value":"2025-03-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}