Melasma is a skin pigmentation disorder characterized by irregular brownish macules, symmetrically distributed in photoexposed areas, most commonly on the face. It is more common in women, with a higher phototype (III-IV) and in fertile age. Due to the high prevalence, the predominantly facial involvement, and the high index of therapeutic recurrence, melasma has an important impact on quality of life, being a frequent cause of dermatological consultations. 1,2 The exact pathophysiology of melasma is not yet known.However, some triggering factors are already well described, such as ultraviolet radiation, pregnancy, use of hormonal therapies, photosensitizing medications, inflammatory stimuli, and stressful events. Genetic factors are also involved, evidenced by the high prevalence of associated family history.

Ectodermal dysplasias are conditions that present primary defects in two or more tissues of ectodermal origin and can be classified as hypohidrotic and hidrotic. Hidrotic ectodermal dysplasia or Clouston syndrome is an autosomal dominant genodermatosis and appears as a triad of clinical findings: palmoplantar keratoderma, nail dystrophy, and hypotrichosis. The hair is sparse and brittle. The nails become thickened and dystrophic, which is an essential characteristic of the syndrome. The diagnosis is made based on clinical findings. This study reports a case of a patient who began with changes in hair, nails and palmoplantar keratoderma in early childhood.

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