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MELASMA

Introduction:

Melasma (also known as chloasma faciei or the mask of pregnancy when present in pregnant women) is a tan or dark skin discoloration.

Signs and Symptoms:


The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Patches can vary in size from 0.5 cm to larger than 10 cm depending on the person. The location of melasma can be categorized as centrofacial, malar, or mandibular. The most common is centrofacial in which patches appear on the cheeks, nose, upper lip, forehead, and chin. The mandibular category accounts for patches on the bilateral rami, while the malar location accounts for patches only on the nose and checks.



Pathogenesis:


Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications.

Treatment:

Assessment by a dermatologist will help guide treatment. Treatments to hasten the fading of the discolored patches include:

  • Topical depigmenting agents, such as hydroquinone (HQ) either in over-the-counter (2%) or prescription (4%) strength. HQ is a chemical that inhibits tyrosinase, an enzyme involved in the production of melanin.

  • Tretinoin, an acid that increases skin cell (keratinocyte) turnover. This treatment is not used during pregnancy due to risk of harm to the fetus.

  • Azelaic acid (20%), thought to decrease the activity of melanocytes.

  • Tranexamic acid by mouth has shown to provide rapid and sustained lightening in melasma by decreasing melanogenesis in epidermal melanocytes.

  • Cysteamine hydrochloride (5%) over-the-counter. Mechanism of action seems to involve inhibition of melanin synthesis pathway

  • Kojic acid (2%) over-the-counter.

  • Flutamide (1%)

  • Chemical peels

  • Microdermabrasion to dermabrasion (light to deep)

  • Galvanic or ultrasound facials with a combination of a topical crème/gel. Either in an aesthetician's office or as a home massager unit.

  • Laser but not IPL (IPL can make the melasma darker)


Top UK Dermatologists Online Consultation
Source: https://en.wikipedia.org/wiki/Melasma

For more information on this topic please click on the links below

Link to British Association of Dermatologists article on dermatology from DermUK
Link to DermNet NZ article on dermatology from DermUK
Link to Medscape dermatology article from DermUK


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