MELASMA

OBJECTIVES

• General definition• Etiology• Signs and Symptoms• Diagnosis• Treatment

WHAT IS MELASMA?

MELASMA (CHLOASMA)

• Melasma is an acquired hypermelanosis of sun-exposed areas.

• Chloasma is a synonymous term sometimes used to describe the occurrence of melasma during pregnancy.

• Chloasma is derived from the Greek word chloazein,meaning "to be green." Melas, also Greek, means "black." Because the pigmentation is never green in appearance, melasma is the preferred term.

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

• Melasma risk increases with increasing sun exposure, the mechanism probably involves overproduction of melanin by hyperfunctional melanocytes.

• Other than sun exposure, aggravating factors include• Autoimmune thyroid disorders• Photosensitizing drugs

PATHOPHYSIOLOGY• Sun exposure: Ultraviolet (UV) light from the sun stimulates

the melanocytes. In fact, just a small amount of sun exposure can make melasma return after fading. Sun exposure is why melasma often is worse in summer. It also is the main reason why many people with melasma get it again and again.

• A change in hormones: Pregnant women often get melasma. When melasma appears in pregnant women, it is called chloasma, or the mask of pregnancy. Birth control pills and hormone replacement medicine also can trigger melasma.

• Cosmetics: Skin care products that irritate the skin may worsen melasma.

MELASMA PRESENTATION

• Melasma consists of dark brown or (It causes brown to gray-brown patches), sharply marginated, roughly symmetric patches of hyperpigmentation on the face

• (usually on the forehead, temples, cheeks, upper lip, or nose).

• Some people get patches on their forearms or neck. This is less common.

MELASMA RISK FACTORS

It occurs primarily in• Pregnant women • Women taking oral contraceptives. • Dark-skinned men.

RISK FACTORS

• Melasma appears on women’s skin much more often than men’s skin. Just 10% of people who get melasma are men. 

• People who have a blood relative who had melasma also are much more likely to get melasma.

• In women, melasma fades slowly and incompletely after childbirth or cessation of hormone use.

• In men, melasma rarely fades.

DIAGNOSIS

• Dermatologists can diagnose most patients by looking at their skin. By  a device called a Wood’s light.

• To rule out another skin condition may need to remove a small bit of skin. This procedure is called a biopsy

TREATMENT

• Melasma can fade on its own.

•  If the melasma does not go away or a woman wants to keep taking birth control pills, melasma treatments are available.

• These include:

HYDROQUINONE:

• This medicine is a common first treatment for melasma. • It is applied to the skin and works by lightening

the skin. It’s came as a cream, lotion, gel, or liquid.

TRETINOIN AND CORTICOSTEROIDS:

• To enhance skin lightening, dermatologist may prescribe a second medicine. • This medicine may be tretinoin or a

corticosteroid. • Sometimes a medicine contains 3

medicines (hydroquinone, tretinoin, and a corticosteroid) in 1 cream. This is often called a triple cream.

OTHER TOPICAL (APPLIED TO THE SKIN) MEDICINES:

• Dermatologist may prescribe azelaic acid or kojic acid to help lighten melasma.

SIDE-EFFECT

• Skin irritation.• Darkening of the skin.• Other problems.

OUTCOME

• Under a dermatologist’s care, many people with melasma have a good outcome.

• Patient can help prevent melasma from returning by wearing sunscreen and a wide-brimmed hat every day.

MANAGING

Patient should:• Wear sunscreen daily• Wear a wide-brimmed hat outside• Choose gentle skin care products• Avoid waxing

REFERENCE

• Merck Manual professional Version.• American Academy of Dermatology.

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