Facial Melanosis in Skin of Color: An Integrated Clinical, Dermoscopic, and Quality of Life Analysis

BACKGROUND: Facial melanosis comprises a heterogeneous spectrum of pigmentary disorders that are particularly prevalent and persistent in skin of color. Despite its frequency, comprehensive data integrating clinical patterns, dermoscopic features, and quality of life impact remain limited, especially from Northeast India. OBJECTIVES: This study aimed to characterize the clinical spectrum of facial melanosis, delineate dermoscopic patterns, including atypical features, and evaluate health-related quality of life using Skindex-16 in a skin of color population. MATERIALS AND METHODS: This hospital-based cross-sectional study included 150 untreated adults with facial melanosis. Participants underwent detailed clinical evaluation, dermoscopic assessment using a polarized video dermoscope, and quality of life assessment with Skindex-16. Diagnoses were classified as standalone or overlapping entities. RESULTS: Twenty-two clinical conditions were identified, with melasma being the most prevalent diagnosis (n = 102, 68.0%), showing a marked female preponderance. Overlapping presentations, particularly melasma with topical steroid damaged face (TSDF), were common. Dermoscopy revealed predominant pigmentary patterns such as brown structureless areas and globules, alongside vascular and appendageal changes. Importantly, infrequent atypical dermoscopic features, rarely reported in facial melanosis, were documented. Quality of life analysis demonstrated a disproportionate emotional burden despite relatively low symptom scores. CONCLUSION: Facial melanosis in skin of color is clinically complex, frequently overlapping, and psychosocially impactful. The integration of dermoscopy and quality of life assessment provides a nuanced, patient-centered understanding, with the identification of atypical dermoscopic features representing a distinctive contribution of this study.