Bilateral Symmetrical Oval Hyperpigmentation on the Face: A Case of Seborrheic Melanosis

Introduction: Seborrheic melanosis is one of the causes of facial hyperpigmentation presenting in the sebaceous areas of the face. It is most commonly seen in Fitzpatrick skin types 4 - 6. Seborrheic melanosis can cause cosmetic concerns for the patients, leading them to seek bleaching methods that could also be hazardous for them. Case Presentation: A 19-year-old male patient presented with dark brown spots on both sides of his nasolabial folds. According to the skin examination, there were nummular oval macules with hyperpigmentation and mild desquamation at the junction of the nasolabial fold and the supralabial area bilaterally. The patient applied an over-the-counter cream that contained hydroquinone to the hyperpigmented areas for bleaching for one month before he consulted our dermatology department. The pigmentation was homogeneous, brown-black, and showed no contrast under Wood’s light examination. Additionally, there were hyperpigmented macules on a seborrheic basement at the alar-supralabial junction bilaterally. The anamnesis and clinical findings supported the diagnosis of seborrheic melanosis. Tacrolimus ointment 0.1% once per night and isoconazole nitrate cream once per day were prescribed as treatments for one month. A water-based moisturizer and sunscreen were also added to the treatment. Further, he used a facial peeling combination of alpha-hydroxy acid 10% and beta-hydroxy acid 2% two times per week. Hyperpigmentation was barely discernible on his face five months after the beginning of the therapy. Conclusions: Seborrheic melanosis must be distinguished from other types of facial melanoses in order to start appropriate treatment. To ensure the most effective treatment, a comprehensive evaluation of the patient’s medical history and a thorough physical examination are essential for an accurate diagnosis of seborrheic melanosis.