A lady develops pigmentation on the bridge of nose and cheeks on exposure to sunlight. The most likely diagnosis is
First, I need to think about skin conditions related to sun exposure. The classic one that comes to mind is melasma. Melasma is known as the "mask of pregnancy" and is common in women, especially those with darker skin types. It's triggered by sun exposure and hormonal changes, like those during pregnancy or from using oral contraceptives.
The other options might include conditions like lupus or photoallergic reactions. But lupus typically presents with a malar rash, which is on the cheeks and bridge of the nose, but it's usually more erythematous and not just pigmented. Also, lupus might have other systemic symptoms. Photoallergic reactions are less common and would involve an allergic response, not just pigmentation.
So, the correct answer here is melasma. The key points are the location (cheeks and bridge of nose), female gender, and sun exposure. The treatment usually involves sun protection and topical agents like hydroquinone.
**Core Concept**
This question tests recognition of **melasma**, a hyperpigmentation disorder triggered by UV exposure and hormonal changes, commonly affecting women. It involves epidermal and/or dermal melanin deposition, often in a **malar distribution** (cheeks and bridge of nose).
**Why the Correct Answer is Right**
Melasma occurs due to increased melanocyte activity in response to UV light and estrogen/progesterone. The pigmentation is symmetrical and exacerbated by sun exposure, making it most common in women of reproductive age. Histologically, it may show increased epidermal or dermal melanin. Management emphasizes sun protection and topical depigmenting agents like hydroquinone.
**Why Each Wrong Option is Incorrect**
**Option A:** *Lupus erythematosus* causes a **malar rash** but is typically erythematous, non-pigmented, and associated with systemic symptoms (e.g., photosensitivity, joint pain).
**Option B:** *Postinflammatory hyperpigmentation* results from prior skin injury (e.g., acne), not direct sun exposure, and lacks the malar pattern.
**Option C:** *Chloasma* is a synonym for melasma, but if listed separately, it would be redundant.
**Option D:** *Photoallergic reactions* involve an allergic response to topical agents (e.g., fragrances) under UV light, presenting as eczematous rashes, not static pigmentation.
**Clinical Pearl / High-Yield Fact**
Remember the **rule of three** for melasma: **30%** of women are affected, **3** key triggers (sunlight, hormones, stress), and **3** treatment pillars (sunscreen, hydroquinone, chemical peels). Avoid misdiagnosing it as lupus by checking for systemic symptoms.
**Correct Answer: C. Melasma**