Article

Aggravating factors for melasma: A prospective study in 197 Tunisian patients

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Abstract

Melasma is a frequent cause of consultations at dermatology departments by dark-skinned patients in Tunisia. To investigate factors that influence melasma severity in a large Tunisian population. A total of 197 patients (188 women and 9 men), who attended Tunis Military Hospital for a consultation were included prospectively from August 2005 to August 2006. Disease severity was estimated using the Melasma Area and Severity Index (MASI). Aggravating factors were investigated using multiple logistic regressions. Of the women included, 14% presented phototype III, 45% phototype IV and 41% phototype V; 76% presented a centrofacial melasma phenotype, 23% a malar and 1% a mandibular phenotype. About 60% developed melasma before thirty. Sun exposure was reported as a triggering factor by 51% of women and as an aggravating factor by 84%. Pregnancy was reported as an aggravating factor by 51% of women who had been pregnant, and oral contraceptive use reported by 38% of women exposed to oral contraceptives. The risk of severe melasma was about three times higher for women with age at onset under 30, phototype V and major lifetime sun exposure and about 8 times higher for women exposed to oral contraceptives. This study identifies a number of factors associated with the severity of melasma. Further epidemiological studies in this type of population, in particular, to investigate triggering factors, are justified by the aesthetic damage caused by melasma in dark-skinned patients, lack of efficacy of existing treatments, non-compliance with photoprotection recommendations and the challenge of treatment.

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... 10 Guinot et al. in Tunisia found that oral contraceptives were reported as an aggravating factor in 38% of melasma. 11 Handel et al. showed a lower number, from 207 subjects found at 10% of melasma due to oral contraceptives. 2 The incidence of melasma due to hormonal contraceptives, especially oral contraceptives was also found lower results in Tamage et al. and Achar et al. studies, with 16.2% and 18.4%, respectively. ...
... 10 Guinot et al. showed a significant association between severity of melasma and duration of oral contraceptive use; melasma often occur between 1 to 3 years after its use. 11 Centrofacial type is the most common clinical pattern seen in hormonal contraceptive acceptors in 9 subjects (52.9%) (table 4.3). Centrofacial is the most common type, which is 63% covering forehead area, nose, medial cheeks, below the nose and chin. 2 This study is similar to Krupashankar et al. that found 45% on centrofacial and 39% on malar. ...
... 18 Guinot et al. also found centrofacial type frequently encountered in the study, which was 76%, malar 23%, and mandibular 1%. 11 This result is different from Jagannathan et al. that shows the distribution of melasma in 80 women obtained that malar 65%, centrofacial 26.25%, and mandibular 8.75%. 19 The result same as Pawar et al., of 120 patients with melasma, all subjects (100%) showed melasma ORIGINAL ARTICLE distribution at malar area, with 76 subjects (63,33%) on forehead and 16 (13,33%) on chin. ...
... Melasma is a multifactorial disorder with a variable interplay between genetic, hormonal, and environmental factors. Sun exposure, family history, and pregnancy are the most commonly observed factors associated with melasma development (2,4,5). On histopathology, there is an increase in epidermal melanin and melanosome number and transfer in epidermal melasma. ...
... The most common clinical pattern is the centrofacial type, followed by maxillary melasma and then mandibular melasma (Figure 1), as observed in various Indian, Brazilian, and Indonesian studies (27,46,47). Similar observations were reported from Tunisia, where the most common type was centrofacial melasma, accounting for 76.1% of all cases, followed by malar (22.9%) and mandibular (1%) melasma (4). However, in a study from Singapore, malar melasma was the type noted in most patients (89%). ...
... Histopathological analysis of biopsies has confirmed significant actinic damage. Therefore, it has been proposed to represent a type of poikiloderma of Civatte (4,30). Extra-facial melasma is a new, less typical pattern. ...
Article
: Melasma is a common dermatosis, presenting as ill-defined light to dark brown pigmentation of photo-exposed areas, most commonly the face. Its exact prevalence is unknown, but it is commoner in intermediate skin phototypes and women of reproductive age. Its treatment and monitoring have significance due to its chronic recalcitrant history and psychosocial impact. Various indices and tools like the Melasma Area and Severity Index (MASI), Melasma Severity Index (MSI), and Melasma Quality of Life Scale (MELASQoL) have been formulated for measuring severity and treatment response. In this review, particular emphasis has been laid on melasma's epidemiological and clinical aspects and its assessment and scoring.
... Melasma is a resistant disfiguring dermatosis, which causes significant emotional and psychological impact on the affected patients (2). There are different classification systems for melasma. ...
... Though there are many lines of melasma treatment, in the absence of any "gold standard", it still remains a challenge for dermatologists. Furthermore, melasma is troublesome because of the very common recurrences among patients (2). ...
... UVA, UVB radiation, and visible light have all been shown to induce formation of new melanin and immediate darkening of preformed melanin (14). The risk of developing melasma substantially increases on exposure to UV light, especially for those who live in the areas of intense UV radiation (2). ...
Article
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Background: Melasma is a common acquired disorder of pigmentation. Objective: To compare the efficacy of oral tranexamic acid (TA) versus oral TA and Q-switched Nd: YAG laser (1064-nm wavelength) in the treatment of melasma. Materials and methods: Sixty patients were divided into two groups. Group A: oral TA only and group B: oral TA plus Qs-Nd: YAG laser (1064 nm) sessions. Evaluations were performed on the clinical basis including the use of Modified Melasma Area and Severity Index (m MASI) and dermoscopy. Dermoscopic examinations were performed before and after the treatment sessions as well as at the 3-month follow up visit. Results: There were statistically significant differences between the two studied groups regarding the change of m MASI after treatment and at the end of follow-up (p = .036) by using dermoscopy. Epidermal type of melasma showed the best response (0.048) and telangiectasias significantly improved in both groups of patients. Conclusions: Low-fluence 1064-nm Qs-Nd:Yag laser is effective and safe line of melasma treatment. Adding oral TA may enhance its clinical efficacy and decrease its side effects or complications. Dermoscopy is an important tool in pigment detection and vascular components in melasma, as well as their response to treatment.
... It is frequently seen in women and mostly starts between the ages of 20 to 40 years. It is characterised by irregular, light to dark brown macules and patches in sun-exposed areas, commonly the face (1,2). ...
... The centro-facial pattern involves the forehead, cheeks, upper lip, nose and chin, while malar pattern involves the cheeks and nose. The mandibular pattern involves the skin over the ramus of mandible (2,4,5). ...
... Pregnancy and oral contraceptives play a major role as hormonal factors. This is evidenced by the fading of the pigmentation after parturition, discontinuation of oral contraceptives and avoidance of sun (1,2,(4)(5)(6). ...
... [1][2][3] Belum banyak pula penelitian tentang karakter pewarisan genetik pada melasma yang berhubungan dengan warna kulit. [4][5][6][7] Warna kulit manusia ditentukan oleh jenis pigmen eumelanin dan pheomelanin yang diregulasi oleh gen melanocortin-1 receptor (MC1R) dan agouti signaling protein (ASIP), serta dipengaruhi oleh letak geografis tempat seseorang tersebut berasal. [7][8][9] Kedua gen tersebut bersifat polimorfisme yang menyebabkan perubahan fungsi protein dalam tubuh sehingga dapat menimbulkan berbagai kelainan pigmentasi yang diwariskan. ...
... 24 Penelitian lainnya di Tunisia menunjukkan interaksi antara genetik dengan lingkungan yang sangat bervariatif dan pada sekitar 10%-70% populasi terdapat riwayat keluarga dengan melasma. 4 Riwayat keluarga dan meningkatnya jumlah pasien melasma pada ras tertentu menunjukkan peran genetik pada kelainan tersebut. Predisposisi genetik paling sering terjadi pada wanita. ...
... Pemeriksaan ini merupakan suatu titik awal yang baik untuk penelitian faktor genetik sebagai salah satu faktor terjadinya melasma. 4,25 Pada dekade terakhir ini di antara beberapa peneliti menduga bahwa melasma merupakan kelainan yang poligenik dan dipengaruhi oleh epigenetik melanogenesis. 22,25 Faktor genetik merupakan salah satu faktor risiko terjadinya melasma, namun belum banyak penelitian tentang hal tersebut. ...
Article
Full-text available
Melasma merupakan kelainan hiperpigmentasi pada wajah dan terdistribusi secara simetris. Lebihbanyak terjadi pada wanita usia reproduktif dan banyak terjadi pada seseorang dengan tipe kulit III-V.Melasma sering memberikan dampak negatif pada kualitas hidup pasien dalam hubungan sosial. Kelainanini sangat sulit diobati dan memerlukan biaya yang cukup mahal, namun sering tidak memuaskan baikbagi pasien maupun dokter yang menanganinya. Patogenesis melasma bersifat multifaktor dan belum dapatdijelaskan sepenuhnya. Faktor genetik, hormon, dan pajanan ultra-violet (UV) merupakan faktor risikomelasma. Dari semua faktor tersebut diduga faktor genetik dan pajanan matahari berperan utama dalampatogenesis melasma. Selain itu riwayat melasma dalam keluarga juga merupakan faktor risiko. Beberapapenelitian terbaru menemukan beberapa ekspresi gen dan melibatkan beberapa jalur yang berperan dalampatogenesis melasma. Gen melanocortin-1 receptor (MC1R) merupakan salah satu gen yang diduga berperansecara genetik pada melasma.Kata kunci: Melasma, genetik, hormonal, pajanan UV dan MC1-R
... Centrofacial melasma was most common type of melasma seen in present study both in male and females. Our findings matched, the studies done 23,24 by Achar and Rathi and Guinot et al. . However, in a study done by Sarkar et al. malar variant was most common type of melasma in males (61%) and centrofacial was most common type in females (51%). ...
... Positive family history was seen in 28.33% of patients in our study which is in correlation with study done by Achar and Rathi and other previous studies where it varied from 20 to 70% in melasma patients according 19 to 24 to populations . A statistically significant association was observed between skin phototype and the prevalence of melasma in an Iranian study by Deharo et al and also in 21,23 Tunisian study by Guinot et al . These data support the fact that skin type 4 and 5 are most commonly affected by melasma. ...
... Sun exposure was a triggering course in 4.3% females and 19.4% males while it was aggravating cause in 56.2% females and 51.4% males. Sun light was reported as a major aggravating cause by 19,23,24 Sarkar et al, Guinor et al and Achar and Rathi . Mustard oil was found to aggravate melasma in 20% male and 6.67% females. ...
Article
BACKGROUND: Melasma is a common acquired hyperpigmentary disorder characterized by irregular light or dark brown macules in sunexposed areas of skin. It is a consequence of specific hyperfunctional melanocytes that cause excessive melanin deposition in skin. AIMS – Our present research aims to study the clinico-epidemological profile and precipitating and aggravating factors of melasma. MATERIAL AND METHODS – Three hundred patients of melasma attending out-patient department of dermatology were included in the study. RESULTS – The mean age of melasma patient in our study was 32.3 years with the female to male ratio of 3:1.The mean age of onset was 26.87 years.The mean duration of disease in present study was 6.23 years. Centrofacial melasma and epidermal type were the most common pattern seen. Familial predisposition, pregnancy, sun-exposure were the most common triggering factors observed. CONCLUSION – The study indicates was melasma has a wide variation in its clinico-epidemological profile and many factors are involved in its etiopathogenesis.
... Melasma, a commonly acquired dermatosis, presents as symmetrical and irregular hyperpigmented tan-brown macules over face (cheeks, forehead, upper lip, nose, and chin) and occasionally over neck in three distinct patterns. Clinically, centrofacial in 55% and 75%, malar in 24% and 43%, and mandibular in 1.5% and 2% patients were observed in two separate studies [1,7]. Depending on the pigment accentuation under Wood's light or its localization, epidermal pattern in 8-66%, dermal pattern in 11-12%, and mixed pattern in 23-80% of cases can occur [3,8]. ...
... Up to 4% of patients seen in dermatology clinics in Southeast Asia have melasma, and it is a common disorder among Indian populations [19]. Its etiology is perhaps multifactorial, and pregnancy, oral contraceptives, endocrine dysfunction, hormonal therapy, photosensitizing drugs (anticonvulsants, phenothiazines, tetracyclines, NSAIDS, fluoroquinolones), cosmetic contact sensitivity, and exposure to ultraviolet (UV) light have been implicated to precipitate melasma in genetically susceptible individuals [7,23]. The pathogenetic role of UV irradiation-induced dermal changes, such as increased dermal vasculature and upregulation of proangiogenic factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), interleukin (IL)-8, has been highlighted only recently [10,18]. ...
... The clinico-epidemiologic features of our patients in both the groups were comparable statistically and corroborate with those described in the literature [1,3,7,8,23,24]. After Nijor in 1979 serendipitously observed the efficacy of TXA, primarily a plasmin inhibitor and anti-fibrinolytic agent, in reducing melasma while treating a patient with chronic urticaria, it is emerging as a favorite treatment modality for melasma in the recent years [6,29]. ...
Article
Full-text available
Oral tranexamic acid (TXA) 250 mg twice daily has been used effectively for 4 weeks to 6 months to treat melasma. As relapses are frequent on discontinuation, a minimum effective dose of TXA that can be used safely for long time remains unknown. We compared the efficacy of oral TXA 250 mg once daily and 500 mg twice daily given for 16 weeks in 132 (m:f 23:109) adults with melasma. 42 patients in Group-A (TXA 250 mg/d) and 46 patients in Group-B (TXA 500 mg twice/d) completed the study. They were followed up at 4-week interval for percentage reduction in baseline Melasma Area Severity Index (MASI) and at 24 and 28 weeks for relapse. Therapeutic response, for both as per-protocol and intention-to-treat analysis, was scored as very good (> 75% reduction), good (51–75% reduction), moderate (25–50% reduction), mild (< 25% reduction) or no improvement. Reduction in mean MASI score at 4 weeks was not statistically significant in Group-A but it decreased significantly 8 weeks onwards and was comparable with that in Group-B. The relapse rate was higher in Group-B (10.8%) than Group-A (4.7%) at the end of 28 weeks. Oligomenorrhoea and abdominal discomfort in few patients did not necessitate treatment discontinuation. TXA 500 mg twice daily showed early reduction in mean MASI score compared to 250 mg given once daily with comparable safety and therapeutic efficacy at 16 weeks. Open-label cross-sectional design, no control arm, small number of patients in each group, MASI score being subjective assessment tool, short duration of treatment and follow-up are study limitations.
... The most common age-distribution in our study was in the age -group of 31-40 years (55.5%) which is similar to the observation reported by Sarkar et al (51.2%). [13] However, in two other studies, [12,17] 33.3% -42% of patients belonged to the age -group 31-40 years. ...
... patients in this study. In three other studies [10,15,17] a family history of melasma was reported is 70.4%, 33.3% and 14.28% of men with melasma. In a study, [19] all patients had a family history, while two patients acknowledged of having an affected male relative. ...
... [19,26] The most common skin type of patients (Fitzpatrick's skin type) in the present study was found to be type IV (brown colour) seen in 46 (63.9%) patients, followed by type III (light brown) in 22 (30.6%) patients and type V (dark brown) in 4 (5.5%), which was similar to the observation is a study done in male melasma patients [6] In another study, [17] skin type IV (55.5%) was the most common followed by skin type V (44.4%). In the present study, the colour of the melasma macule was light brown in 38 (52.8%) patients, bluish grey in 19 (26.4%) patients and dark brown/black in 15 (20.8%) patients. ...
Article
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. There is paucity of data regarding the aetiological factors and clinical presentation of melasma in men. The present study was taken up to fill this lacuna and to understand the unique aspects of melasma in this group. Methods: Study was conducted in the Department of Dermatology at University teaching hospital from January 2015 to July 2016. A total of 72 male patients with melasma were studied. A detailed history including occupation, onset, duration and evolution of melasma, predisposing factors like sun exposure and genetic factors, were taken followed by general physical examination, cutaneous examination and Woods lamp examination and recorded in a proforma. Laboratory investigations like complete haemogram, hormonal profile, liver function tests were done whenever necessary depending on the presenting condition. Results: The mean age of onset was 31.5 years. The duration of melasma varied from 3 months to 6.5 years. The aetiological factors identified were, sun exposure in 42 patients (58.3%) and family history in 29 (40.3%). Laboratory investigations revealed hepatic disorders in 5 patients(6.9%), increased luteinizing hormone (LH) and low testosterone in 2 (2.8%) and hypothyroidism in 4 patients (5.6%). According to clinical patterns, malar pattern was seen in 65.3% of patients, centro-facial in 31.9% and mandibular in 2.8% of patients. The most common skin type found to be type IV. Conclusion: Melasma was evident in men in their fourth decade of life; malar pattern, type IV skin type were most commonly seen.
... This was comparable to the previous study. [22] Significantly decrease in MASI score 2.4 was found in group I from baseline (15.4)and in group II MASI score decreases to 5.6. Intradermal tranexamic acid (TA) in the treatment of melasma was effective and safe method as compared to triple base combination. ...
... Our findings were comparable to the previous some studies. [20][21][22][23][24][25][26][27] ...
Article
Objective: To evaluate the efficacy of intradermal tranexamic acid (TA) verses fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%)therapy in the treatment of melasma. Study Design: Randomized comparative trial Place and Duration: Study was conducted at outpatient dermatology department of Sheikh Zayed hospital Rahim Yar Khan for period of six months i.e from September 2020 to February 2021. Methods: Total 110 patients (age 18-40 year) of both genders having melasma on face were enrolled. Patients details demographics, age, sex and body mass index were recorded after taking written consent. Patients were divided into 2-groups. Group I had 55 patients and received intradermal tranexamic acid and group II had 55 patients andwere given topical fluocinolone-based triple combination (hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%) cream. Follow up was taken for 2-months to determine efficacy and safety. Complete data was analyzed usingSPSS 22.0 version. Results: Out of 110 patients 60 (54.54%) were females and 50 (45.46%) were males. Mean age of the patients in group I was 29.15±5.14 years with mean BMI 24.16±7.22 kg/m2 and in group II mean age was 28.17±5.18 years with mean BMI 23.61±2.48 kg/m2. Most of the patients (85 or 77.27%) had mixed melasma followed by dermal (16 patients /14.54%) and epidermal melasma(9 patients/8.18%). We found that malar-type pattern of melasma was most common, found in 66 (60%) of cases. A decrease in MASI score from baseline (15.4) was found 2.4 in group-Iand 5.6 in group-II. In group II erythema, hypertrichosis, hypopigmentation and acneiform lesions were the side effects found but there was no clinically significant side effect found in group I patients. Conclusion: We found in this study that use of intradermal tranexamic acid (TA) in the treatment of melasma was effective and safe because there were no clinically significant side effects found after this treatment and reduction of MASI score was also significant. Keywords: Triple combination, Melasma, MASI, Intradermal tranexamic acid
... Also, the study by Sarkar et al. [13] showed that occupation wise, the majority of the study participants were homemakers (53.9%), but the second commonest and a sizeable segment of the study sample were professionals (11%). Additionally, the study by Guinot et al. [19] found that only three patients reported a family history of melasma. Another study by Ali et al. [20] showed that mean age of the patients was 29.90 ± 7.18 years. ...
... Also, the study by Dogra et al. [23] showed that the main precipitating factor in both the groups was pregnancy (44%). Additionally, the study by Guinot et al. [19] found that among 197 patients with melasma, nine (5%) were men with skin types IV and V. Exposure to sunlight was cited as a triggering factor in five men, and as an aggravating factor in eight men. ...
... 1, 2 The pathogenesis of melasma remains unknown, but multiple factors including UV exposure, genetic factor, inflammation and female sex hormones have been implicated and reviewed. 3 Melasma is classified according to clinical and histological features. Three common type melasma on face are centrofacial, malar, and mandibular. ...
... Based on pigment location, it may be epidermal, dermal or mixed. 3,4 This classification is important to define treatment options and prognosis. ...
Article
Full-text available
Background: Melasma is acquired chronic hyperpigmentation mainly affecting women. The pathogenesis of melasma is uncertain, but it is predominantly related to ultraviolet (UV) exposure. Due to its chronic and relapsing nature, melasma is challenging to treat. The currently available treatment often has undesirable side effects and suboptimal results. The treatment principle includes protecting from UV radiation, inhibiting melanin synthesis, and increasing the pathway to remove melanin. Objectives: To define available treatments for melasma and determine advantages and disadvantages, including topical, oral and procedural. Method: Medline, Cochrane library and PubMed databases were searched for articles from January 2011 to June 2020. Only RCTs, comparative, prospective, retrospective and systematic reviews focusing on melasma treatments were extracted, analyzed and discussed. Results: We found 197 studies that met the inclusion and exclusion criteria, with 2314 participants included in this review. The treatments included topical, oral and procedural. In several studies, hydroquinone alone or combination remains the most effective treatment for melasma. Oral and topical tranexamic acid is a beneficial adjuvant treatment in refractory melasma with minimal adverse effects. Procedural treatments such as chemical peels, laser and light-based therapies, and microneedling have mixed and unpredictable results. Overall, the side effects tend to be mild and affect a few of the subjects. Conclusions: The current state of the evidence suggests that some treatments with multiple modalities have their respective advantages and disadvantages. The choice of treatment modality must be adjusted according to the type of melasma, such as its severity, extent and location. A better understanding of melasma through further research may improve the therapy options with the least adverse effects.
... 1 The most important epidemiological correlation is between melasma and sex, as women are at 7 to 9 times greater risk of developing melasma relative to men. 2 Other strong links are suggested between melasma and pregnancy, oral contraceptive intake, and darker skin phototypes (Fitzpatrick skin types III-IV). [3][4][5] The etiopathogenesis of melasma is complex and not completely understood. It results from an interplay of several internal and external factors. ...
... Similarly, a study by Guinto et al, 4 which included 188 Tunisian women, reported the same previous triggering factors for melasma. Speci cally, it recorded regular removal of unwanted facial hair in 56 percent, sun exposure as a triggering factor in 51 percent, pregnancy as an aggravating factor in 51 percent, and oral contraceptive use in 38 percent of study participants. ...
Article
BACKGROUND: A number of treatments have been used to treat melasma, with varying degrees of success and side effects. OBJECTIVE: We sought to compare the efficacy of a single session of low-power fractional CO2 (10,600 nm) laser followed by Jessner's solution peeling against that of Jessner's solution peeling alone for the treatment of melasma by way of a prospective cohort comparative study performed at Alexandria Main University Hospital in Alexandria, Egypt. This study included 40 Egyptian female patients diagnosed with melasma. Group A received a single session of low-power fractional CO2 laser followed by Jessner's solution peeling for up to six sessions, while Group B received up to six sessions of Jessner's solution peeling alone. Responses were evaluated using the modified Melasma Area and Severity Index (mMASI) score. RESULTS: There was a statistically significant (p≤0.001) difference between mMASI score between before and after treatment in both groups. There was no intergroup significant difference in mMASI score improvements. CONCLUSION: Both low-power fractional CO2 laser combined with Jessner's solution and Jessner's solution peeling alone were safe and effective for the treatment of melasma in patients with different skin types, especially in dark skin types (Fitzpatrick Skin Types III and IV).
... 4,5 Melasma is common in women, dark skinned individuals and high UV index countries. 6 Depending on the sites of involvement over face, melasma is classified into three types: centrofacial, malar and mandibular. The centrofacial pattern includes the lesions over the forehead, nose, cheeks, upper lip and chin. ...
... This finding is in great contrast to Guinot et al who reported 84%, Achar et al showing 55.12% sun exposure as an aggravating factor. 6,12 As majority patients in our study were housewives, they were not aware that even < 1 hour of exposure is causing melasma. None of the patients pointed solar radiation as triggering factor. ...
Article
Full-text available
p> Background: Melasma is a chronic hyper pigmentary disorder mainly affecting females. It presents over the sun exposed areas of face. Various factors implicated in the etiology are sun exposure, pregnancy, OCPs, hormonal therapy, thyroid disorders, cosmetic use etc. The major causative factors are genetic predisposition and sun exposure. This study was aimed at studying the relation between duration of sun exposure and melasma development. Methods: 100 patients diagnosed with melasma were included. Detailed history was taken and clinical examination done. Modified MASI score was calculated. Patients were divided into four groups depending on hours of sun exposure. Data was collected in a proforma, tabulated and analyzed. Results: F: M ratio was 3.54:1 with 78% females and 22% males. 46% of females were in 4<sup>th</sup> decade and 72% of males were in their third decade. 35% of females were in 21-30 years age. Third decade was the commonest age of onset seen in 49% of patients. 46% patients had <1 hour and 23% had >6 hours of sun exposure per day. A p value of 0.0006 was found between the mMASI scores of group A and group D which was highly significant. Conclusions: More number of young males with melasma in their third decade are seeking treatment. Increase in the duration of exposure to solar radiation leads to more severe melasma. So, sun exposure is a major aggravating factor. There is a need to create awareness about sun protection. </p
... and Guinot et al.27 All these clinico-demographic features corroborate with the reviewed literature. ...
... Sun exposure was found to be the most common (80%) aggravating factor in melasma patients; next common was pregnancy with 50%. Guinot et al. [26] concluded the same. In the study by Achar and Rathi, [17] about 55.12% of patients reported that their disease exacerbated during sun exposure. ...
Article
Full-text available
Background: Melasma, a hypermelanotic disorder, is challenging to treat as it needs long-term management. Intradermal tranexamic acid (TA), a plasmin inhibitor, has been tried for melasma in Korean and Iranian patients but not studied in skin type of Indian patients. TA cream topically as well as fluocinolone-based triple combination along with intradermal TA have not been studied in the literature so far in melasma. Objective: This study is designed to study the efficacy of intradermal TA vs topical TA vs triple combination (hydroquinone 2%, tretinoin 0.025%, fluocinolone acetonide 0.01%) for the treatment of melasma. Materials and Methods: A total of205 patients of melasma attending Dermatology OPD were enrolled in the study and randomly assigned into three groups. Groups A, B, and C were given intradermal TA, topical 3% TA, and triple combination, respectively, from November 2016 to May 2018 and asked to follow-up every month for 6 months. Total 180 patients completed the study and clinical evaluation was done using melasma area severity index (MASI) score. The results were analyzed using SPSS-22 and comparison of three groups were assessed by applying analysis of variance. Results: The MASI score at baseline and at 6 months for Groups A, B, and C was 15.4 and 2.2, 15.4 and 6.4, and 15.3 and 5.4, respectively. MASI score decreased in all three groups but it was statistically significant in Group A (TA group) that had the least MASI score followed by triple combination therapy. Conclusion: On the basis of these results, TA can be used as potentially a new, effective, safe, and promising therapeutic agent in melasma.
... The exact underlying etiology of melasma remains a mystery and several well known risk factors exist [9,10] . Genetic predisposition is suggested by a high reported incidence in family members in several studies and it has been reported in identical twins without affecting other siblings [11] . ...
... This was consistent with another prospective study that evaluated aggravating factors of melasma. 31 It should be mentioned that recurrence rate in the current study was less than other studies evaluating other treatment modalities. 22,32 This might be explained by microneedling which allowed the delivery of sufficient concentrations of vitamin C into the skin, that enforced the depigmenting effect of vitamin C and decreased the recurrence rate. ...
Article
Full-text available
Background: Melasma is a common dyschromia that often motivates the search for dermatological care as it results in cosmetic disfigurement that impairs the patient’s quality of life. Aim: To evaluate the effect of microneedling with addition of topical vitamin c in treatment of melasma. Materials and Methods: This is a prospective study that included 34 adult females with 4 dropouts. All had epidermal melasma. The thirty cases who completed the study received 6 sessions of microneedling with topical vitamin C 20% at 2 week interval. All came for follow up after 3 months of the last session. Patients were evaluated by digital photographs taken at each visit and Melasma Area Severity Index (MASI scoring). Results: The percentage improvement of the studied cases showed gradual increase from the first session (mean= 0) to the last session (mean= 36.87±19.85) and this was highly significant (P value <0.0001). After 3 months of the last session, 5 cases (16.67%) showed recurrence and 25 cases (83.33%) showed no recurrence.There were no major adverse events observed. Conclusions: On the basis of these results, microneedling with topical vitamin C is a promising treatment option for epidermal melasma especially in fair skinned patients.
... This was consistent with another prospective study that evaluated aggravating factors of melasma. 31 It should be mentioned that recurrence rate in the current study was less than other studies evaluating other treatment modalities. 22,32 This might be explained by microneedling which allowed the delivery of sufficient concentrations of vitamin C into the skin, that enforced the depigmenting effect of vitamin C and decreased the recurrence rate. ...
Article
Full-text available
Background: Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging. Objectives: To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma. Methods: Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement. Results: Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P < 0.0001). Conclusion: Microneedling with topical vitamin C is an effective and safe treatment option for epidermal melasma especially in Fitzpatrick skin phototypes I‐III. KEYWORDS dermaroller, melasma, microneedling, vitamin C
... In this study, the investigators say that melasma represents about two thirds of all cutaneous secondary effects of oral contraceptives. (34) In short: Most studies in this category reject the hypothesis that hormonal contraceptives implicate hyperpigmentation situations, as described by Krupashankar ...
Article
Full-text available
Introduction: Melanocytes are cells which are present in the human skin and they are responsible for the melanin production. They can be found in the basal stratum of the epidermis and they have some prolongations extending until the stratum corneum. Melanin synthesis may increase in the presence of some factors and some irregular brownish spots – hyperpigmentations – may appear. Factors which can trigger melanogenesis are excessive sun exposure, hormonal contraception, hormonal reposition therapy, pregnancy, medicines, cosmetics, stress or genetics. Aim: Understanding of the relationship between hormonal contraceptives and hyperpigmentation. Material and Methods: A bibliographic review through a research in diverse databases (PubMed, Google Scholar, ScienceDirect and Wiley Online Library). Results/Discussion: According to some authors, estrogenic components found in hormonal contraceptives are associated with hyperpigmentation situations. In the case of progestagenic components, opinions diverge: some studies substantiate that progesterone has the ability to increase melanogenesis and others that it may have the opposite effect of estrogen. In a general way, most researchers say that hormonal contraceptives affect melanin synthesis; however others reject that fact. Conclusion: It is verified the relationship between hormonal contraceptives and hyperpigmentation. However, this topic is not sufficiently well approached, so future investigations are needed to allow its best understanding.
... The exact pathogenesis of melasma is not yet clearly defined; however, some etiological factors have been identified, including genetic background, pregnancy, hormonal therapies, and sun exposure. Melasma has a significant psychological effect on the affected patients because of its disfiguring nature [4]. ...
Article
Background Melasma is an acquired disorder of symmetrical hypermelanosis that involves sun-exposed areas of the skin. Although multiple therapeutic modalities have previously been tried, successful, truly effective treatment options for this condition have been few and quite elusive. Objectives To compare the therapeutic efficacy of topical tranexamic acid (TXA) with microneedling versus microneedling alone in the treatment of melasma and to evaluate the changes that occur clinically, histologically, and immunohistochemically. Patients and methods This study was conducted on 42 patients with melasma, randomly divided into two groups. In group I, each patient was subjected to a series of six sessions of skin microneedling and TXA application, whereas in group II, six sessions of microneedling alone were performed, with 2-week interval. Results Clinically, the mean melasma area and severity index (MASI) score was significantly decreased in both groups with statistically significant higher reduction scores in group I compared with group II. Histopathologically, epidermal hyperpigmentation and dermal melanophages were significantly reduced after treatment with more obvious reduction in group I. The number of melanoma antigen recognized by T cells-1-positive cells showed significant reduction in both groups; this reduction was statistically higher in group I than group II. Conclusions Although microneedling alone produced significant lightening effect, topical TXA combined with microneedling achieved more satisfactory results.
... In this study, the investigators say that melasma represents about two thirds of all cutaneous secondary effects of oral contraceptives. (34) In short: Most studies in this category reject the hypothesis that hormonal contraceptives implicate hyperpigmentation situations, as described by Krupashankar ...
Article
Full-text available
Introduction: Melanocytes are cells which are present in the human skin and they are responsible for the melanin production. They can be found in the basal stratum of the epidermis and they have some prolongations extending until the stratum corneum. Melanin synthesis may increase in the presence of some factors and some irregular brownish spots – hyperpigmentations – may appear. Factors which can trigger melanogenesis are excessive sun exposure, hormonal contraception, hormonal reposition therapy, pregnancy, medicines, cosmetics, stress or genetics. Aim: Understanding of the relationship between hormonal contraceptives and hyperpigmentation. Material and Methods: A review of literature study by researching in diverse databases (PubMed, Google Scholar, ScienceDirect and Wiley Online Library). Results/Discussion: According to some authors, estrogenic components which can be found in hormonal contraceptives are associated with hyperpigmentation situations. In the case of progestagenic components, opinions diverge: some studies substantiate that progesterone has the ability to increase melanogenesis and others that it may have the opposite effect of estrogen. In a general way, a few researchers say that hormonal contraceptives affect melanin synthesis while others reject that fact. Conclusion: It is verified the relationship between hormonal contraceptives and hyperpigmentation. However, this topic is not sufficiently well approached, so future investigations are needed to allow its best understanding. Keywords: Hormonal contraceptives; Hyperpigmentation; Estrogen; Progesterone
... This was consistent with another prospective study that evaluated aggravating factors of melasma. 31 It should be mentioned that recurrence rate in the current study was less than other studies evaluating other treatment modalities. 22,32 This might be explained by microneedling which allowed the delivery of sufficient concentrations of vitamin C into the skin, that enforced the depigmenting effect of vitamin C and decreased the recurrence rate. ...
Article
Background Despite the wide therapeutic options available for the treatment of melasma, including many active topical medications, technologies with lights and peelings, clinical control of this disorder is extremely challenging. Objectives To evaluate the effect of microneedling with topical vitamin C in the treatment of melasma. Methods Thirty female patients with melasma received six sessions of microneedling with addition of topical vitamin C every two weeks. At each session, photos were taken and Melasma Area and Severity Index (MASI) score was calculated to assess the clinical improvement. Results Mean age of the eligible patients was 33.2 ± 5.77 years. About 50% of cases were of Fitzpatrick skin type III. All patients showed improvement at the end of the sessions. Mean MASI score in the first session was 8.61 ± 4.45 and there was a gradual decline in its value till it reached a mean of 5.75 ± 4.16 in the last session (P < 0.0001). Conclusion Microneedling with topical vitamin C is an effective and safe treatment option for epidermal melasma especially in Fitzpatrick skin phototypes I‐III.
... This type of hyperpigmentation is more resistant to treatment than pregnancy-related cases. 10 Progesterone and estrogen receptor expression is higher in the dermis and epidermis of pigmented skin and stimulate melanogenesis, 2,8 with estrogen-inducing melanogenic enzymes such as tyrosinase, tyrosine-related protein 1, tyrosine-related protein 2, and melanocyte-inducing transcription factor. The progesterone effect in melasma is controversial. ...
... Pigmented cosmetic dermatitis pattern to be the most common [10,11]. The most common precipitating factor was pregnancy (58.2%) in our study followed by OCP's and hormonal supplements (17.9%) thus giving impetus to the role of hormones in its genesis which has been reported in other studies as well [12][13][14]. ...
... 3,4 Some studies such as one in Tunisia showed the role of genetics was found in 10-70% of the population who suffer from melasma and have a history of skin diseases in their families. 5 Another study reported that 50% of individuals with darker skin also had a family member who suffers from melasma. 6 Melasma often has a negative effect on the quality of life (QoL) of the sufferer's social interaction and also causes stress on daily activities due to the lack of self-confidence because of their appearance. ...
Article
Full-text available
Introduction: Melasma is an acquired hypermelanosis of the face. The pathogenesis of melasma is multifactorial and may be caused by interactions between genetics and the environment. Research has shown that skin pigmentation is regulated by the Melanocortin-1 Receptor gene (MC1R). In Japanese populations, Val92Met and Arg163Gln genotypes of MC1R gene polymorphisms are associated with freckles and lentigo solaris, because they have skin types II-III, but for Indonesians who are skin type IV, hyperpigmentation disorders are often melasma. Purpose: This study aimed to identify the association between Val92Met and Arg163Gln genotypes of MC1R gene polymorphisms with the incidence of melasma in a Javanese women population. Patients and methods: This study used unmatched case-control design, conducted by clinical examination and questionnaire. Data were analyzed with Chi-squared test and Odds Ratio (OR). Results: This study evaluated 158 Javanese women from 18-60 years old with 79 case and 79 control subjects. The genotype of Val92Met was found more common in melasma subjects than in non-melasma (p=0.005) with (OR2.53; 95% CI:1.21-5.29). By using a bivariate test we showed sun exposure and family history of melasma were risk factors for melasma (OR:1.99; 95% CI:1.04-3.78) and (OR:35.32; 95% CI:10.25-121.70). However, genotype of Arg163Gln was not a risk factor for the incidence of melasma (OR: 0.86; 95% CI:0.39-1.89). Conclusion: The findings showed Val92Met genotypes, sun exposure and family history were risk factors for melasma incidence. This is the first study on incidence of melasma in an Indonesian population and contributes to ongoing efforts to understand the mechanisms of melasma.
... Pregnancy and sun exposure have been reported to be triggering factors for melasma in previous studies. 9,11 In this study, a significant proportion of the study population (15.2%) reported onset of melasma during pregnancy, of whom more than half noticed it first during the second trimester. ...
Article
Full-text available
Background Though melasma is a common skin condition in India, epidemiological studies are few and geographically confined. The present study was designed to gain insights into factors involved in causation and aggravation of melasma, demographic distribution, clinical presentations, and treatment patterns. Methods A cross‐sectional multicentric study was conducted in 10 centers distributed across the four regions of India. Data including demographics, personal and family medical history, triggering and aggravating factors, clinical patterns, and details of past treatment regimens were recorded, and severity was estimated using the modified Melasma Area and Severity Index (MASI) score. Data collected by site dermatologists were collated and analyzed. Results The study evaluated 1,001 patients with melasma from 10 centers. Mean age was 38.02 years. Females dominated (85%). Proportion of males was highest in the east (22.2%) and lowest in the south (10.8%). Majority of patients belonged to intermediate skin phototypes. There was a significant difference (P = 0.000) between duration of sun exposure and duration of cooking fire/occupational heat exposure across the four regions. There was a significant association (P = 0.003, Mann‐Whitney U test) and a positive correlation between duration of cooking heat/occupational heat exposure and severity of melasma. Sunscreens were used by only one‐fifth of the study population (19.6%) whereas use of steroids and triple combinations was more common (28%). Conclusion One of the largest studies on melasma from the subcontinent, this study describes the epidemiological determinants of melasma. Data suggests that the duration of cooking fire/occupational heat exposure may be linked to severity of melasma. Sunscreen use seems inadequate in Indian patients; use of steroid‐containing medications is more common.
... Melasma is a common pigmentary disorder characterized by asymmetrical, hyperpigmented macules and dark patchy skin that develops in sun-exposed areas, especially the face and neck (Guinot et al., 2010;Tamega Ade et al., 2013). In the United States alone, melasma affects more than 5 million people (Grimes, 1995). ...
Article
Melasma is a pigmentary disorder characterized by hyperpigmented patchy skin in sun-exposed areas, especially the face. Treatment of melasma can be challenging because long-term therapy is required, reoccurrence is common, and existing therapies are insufficient and unsatisfactory. To investigate new treatment options, we performed an exploratory double-blinded, randomized split-face study to assess the efficacy of the tyrosinase inhibitor Thiamidol compared to hydroquinone in women with mild to moderate melasma. After 12 weeks, modified Melasma Area and Severity Index scores significantly improved on both the Thiamidol-treated and the hydroquinone-treated sides of the face. Additionally, Thiamidol treatment improved modified Melasma Area and Severity Index scores significantly better than hydroquinone, and more subjects improved following treatment with Thiamidol (79%) compared with hydroquinone (61%). During treatment, no subjects displayed worsening of modified Melasma Area and Severity Index scores on the Thiamidol-treated side, while approximately 10% of the subjects showed a worsening of modified Melasma Area and Severity Index scores on the hydroquinone-treated side. All subjects routinely used sunscreens and consistent results were obtained in low and in high UV ambient conditions. Subjects rated the efficacy of the Thiamidol formulation significantly better with regard to overall decreased intensity of dark spots and their overall appearance throughout the study. Thiamidol was well-tolerated and well-perceived and represents an effective agent to reduce hyperpigmentation.
... 15 Penelitian dari Guinot dkk. 16 yang dilakukan pada pasien dengan melasma melaporkan bahwa penggunaan kontrasepsi oral merupakan faktor pencetus pada 26% pasien dan faktor yang memperburuk gejala pada 38% pasien. Hasil penelitian ini menunjukkan hubungan yang bermakna antara derajat keparahan klinis melasma dengan penggunaan kontrasepsi oral, yang diduga terjadi sebagai akibat stimulasi melanogenesis oleh estrogen dan progesteron. ...
Article
Melasma adalah kelainan hipermelanosis didapat, ditandai dengan makula hiperpigmentasi yang terdistribusi secara simetris pada bagian tubuh yang terpajan sinar matahari, terutama wajah. Patogenesis kondisi ini belum diketahui secara pasti. Berbagai faktor telah diketahui berkaitan dengan terjadinya melasma, yang tidak berdiri sendiri.Sistem neuroendokrinologi pada kulit berperan secara lokal dan sistemik melalui jaras humoral dan neurologis untuk menginduksi perubahan vaskular, imunitas, atau pigmen. Sistem ini juga berfungsi menjaga dan memelihara integritas struktur dan fungsi kulit, dan penting dalam homeostasis kulit. Perubahan pada sistem neuroendokrinologi kulit dapat berpengaruh dalam berbagai jenis kelainan kulit, salah satunya melasma. Keterlibatan neurologis pada melasma terutama berhubungan dengan peningkatan ekspresi nerve growth factor receptor (NGFR) dan neural endopeptidase (NEP) serta hipertrofi serabut saraf dermis. Terkait dengan faktor endokrin sejumlah penelitian menunjukkan hasil yang konsisten mengenai keterlibatan hormon estrogen, progesteron dan hipofisa. Mekanisme patogenesis melasma bersifat heterogen. Pemahaman patogenesis khususnya aspek neuroendokrinologi dapat memberikan terobosan untuk menyelesaikan kesulitan terapi melasma.Kata kunci: hormone, neuroendokrin, melasma, patogenesis
... Hexsel et al., in his study, found skin types II, III to have an onset of melasma earlier than patients with phototypes IV, V, VI. 12 Guinot et al. also showed a correlation between age of onset and MASI score. 19 Mean duration of daily sun-exposure was 53.36±87.755 minutes. ...
Article
Full-text available
p> Background: Melasma, a multifactorial disease, constitutes the most common facial melanosis in Indian population. Methods: 119 cases of melasma aged 18 years or above were enrolled. Detailed history, examination and laboratory investigations were done. Results: 20 (16.8%) were males and 99 (83.2%) females. Mean age was 35.25 years. Disease duration was more than 1 year in 102 (85.7%), 6 months to 1 year in 10 (8.4%) and less than 6 months in 7 (5.9%). 22 (18.49%) had occupation-related increased duration of sun-exposure 19 (86.3%) or heat-exposure 3 (13.6%). 79 (66.4%) had skin type IV, 26 (21.8%) type III, 14 (11.8%) type V. Centrofacial was commonest distribution pattern in 87 (73.1%), malar in 30 (25.2%), mandibular in 2 (1.7%). Mean duration of daily sun-exposure was 53.36 minutes (male-124.75, female-38.94). Mean Melasma Area and Severity Index (MASI) score was 11.602. There was significant association between MASI and skin type (p<0.001). Other etiological factors were: Oral Contraceptive Pills (OCPs) use in 17 (17.17%), melasma during pregnancy in 39 (39.4%), family history of melasma in 24 (20.2%), hair dye use in 66 (55.5%), cosmetics use in 19 (16%), mustard oil use in 31 (26.1%), mustard oil along with other oil(s)’ use in 39 (32.8%). Laboratory investigations revealed anemia in 60 (50.42%), dyslipidemia in 73 (61.34%), abnormal thyroid function test in 26 (21.85%), serum vitamin B12 deficiency in 35 (29.4%) and vitamin D deficiency in 94 (79%). Conclusions: Higher skin phototypes should be cautious about general measures and associated risk factors (hair dye/oils, cosmetics). Increased daily sun-exposure, OCPs use, pregnancy, thyroid disorders are risk factors. Housewives and indoor occupations should be advised physical sunscreens for protection against infra-red radiation. Anemia, dyslipidemia, thyroid dysfunction, vitamin D and B12 levels can be assessed although their exact role in perpetuating/precipitating melasma needs further studies</p
... In our study out of 110 patients, 99(90%) had Fitzpatrick skin type IV, followed by Fitzpatrick skin type V in 6(5.5%) patients and Fitzpatrick skin type III in 5(4.5%) patients. In a sample of 302 Brazilian patients, 34.4% had skin type III, 38.4% had skin type IV and 15.6% had skin type V. 6 In Tunisia, a survey of 188 women showed that: 14% had skin type III, 45% had skin type IV and 40% had skin type V. 7 This is in accordance with our study as Fitzpatrick skin type IV is the predominant type. ...
Article
Full-text available
Melasma is an acquired hypermelanosis that occurs exclusively in sun-exposed area mostly on face and rarely on the neck and forearms. It is more common in women and in Asians. Exact pathogenesis remains elusive, however, genetic predisposition and ultraviolet light exposure seem to play an important role. The aim of this study was to evaluate facial melasma clinically and dermatoscopically and to compare the consistency of the findings with respect to each type of melasma. Dermatoscopy is increasingly being used for diagnosis of pigmentary disorders other than malignancy. Hospital based cross sectional descriptive study. Study was conducted in the Dermatology department of Yenepoya Medical College and Hospital on 110 patients during the period of December 2016 to June 2018.Clinical examination includes standard dermatological examination along with Wood’s lamp and dermatoscopic examination (Detailed format attached). Heine Delta 20 plus Dermatoscope was used for evaluation of the lesions. : A total of 110 patients with clinical diagnosis of melasma attending the Department of dermatology in Yenepoya medical college were studied during a period of 18 months. Maximum number of patients (35.5%) belonged to the age group between 31 and 40 years. Study showed a female preponderance (69.1%) . On the basis of Fitzpatrick skin type, patients with Type IV (90%). With respect to occupation housewives (60%) and manual labourers /farmers (25.5%) formed the majority indicating chronic sunexposure to be a leading cause for melasma. Patients having Centrofacial pattern predominated with 59.1% of the total. In 43.6% of the women cycles were regular, 5.45% had irregular cycles and 20.9% of the women had attained menopause. We found that 66.4% of the patients had a moderate MASI score. Under Wood’s lamp examination patchy enhancement was seen in 56.4% of the patients indicating a mixed pattern. Among the various patterns observed reticuloglobular pattern dominated our study with 85.45% of patients being positive for the pattern. In our study patients presented with some additional features under dermatoscopy namely telangiectasia (36.1%), followed by depigmentation (24.5%). On the basis of dermatoscopy, 64.5% predominantly showed an epidermal pattern. Dermoscopy serves as useful tool in assessing the type of melasma based on the MASI score.
... gave history of using sunblock. The UV radiation triggers DNA damage in the nuclei of keratinocytes, this leads to production of melanin by the melanocytes 23 . The UVA and UVB main radiations contribute to melanogenesis; however Infrared radiation and visible light have a low melanogenic potential 24 . ...
... Along with pregnancy, direct sun exposure is the leading risk factor for melasma, reported by 27-51% of patients as a trigger and 84% as a factor of clinical impairment [6,7]. Patients with melasma usually report occupational or intentional sun exposure. ...
Article
Full-text available
Melasma is a prevalent chronic relapsing pigmentary disorder that affects photoexposed areas, especially in women of childbearing age. Although there is currently no curative treatment available for melasma, this manuscript critically reviews the knowledge regarding photoprotection, topical and oral therapies, and procedures such as peelings, laser, and microneedling that represent the main strategies for control and prevention of this disease. As the pathogenesis of melasma is not entirely understood, there are prospects for the development of new therapeutic strategies that might act on the pathways that promote sustained pigmentation rather than merely decreasing melanin synthesis and removing melanin from the epidermis.
... Hormonal imbalances due to pregnancy, ovarian tumors, hormonal replacement therapy, and hormonal contraceptives stimulate melanogenesis [42]. However, the prevalence of melasma following hormonal stimuli varies: 14.5-56% of melasma cases occur in pregnant women, while 11-46% are associated with hormonal contraceptive use [2,4,5,43,44]. ...
Article
Full-text available
Melasma is a multifactorial dyschromia that results from exposure to external factors (such as solar radiation) and hormonal factors (such as sex hormones and pregnancy), as well as skin inflammation (such as contact dermatitis and esthetic procedures), in genetically predisposed individuals. Beyond hyperfunctional melanocytes, skin with melasma exhibits a series of structural and functional alterations in the epidermis, basement membrane, and upper dermis that interact to elicit and sustain a focal hypermelanogenic phenotype. Evolution in the knowledge of the genetic basis of melasma and the cutaneous response to solar radiation, as well as the roles of endocrine factors, antioxidant system, endothelium proliferation, fibroblast senescence, mast cell degranulation, autophagy deficits of the melanocyte, and the paracrine regulation of melanogenesis, will lead to the development of new treatments and preventive strategies. This review presents current knowledge on these aspects of the pathogenesis of melasma and discusses the effects of specific treatments and future research on these issues.
... Other frequently implicated etiologic factors include pregnancy, oral contraceptives, endocrine dysfunction, hormone replacement treatments, thyroid disorders, drugs, cosmetic contact sensitivity, light exposure including both sun and artificial light and stress. 7,8 Pigmentation is usually confined to the epidermis, but dermal factors have been implicated for its recurrent and refractory nature. Ultraviolet (UV) irradiation induced increased proliferation on dermal vasculature proliferation and upregulation of dermal proangiogenic factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and interleukin (IL)-8) have been implicated in the pathogenesis of melasma. ...
Article
Full-text available
Melasma is a common malady affecting all races with a higher incidence in Hispanics, Middle Eastern, Asians and African origin females (Fitzpatrick skin phototypes III‐V). Women are affected much more often than men. Melasma remains a significant cause of cosmetic morbidity and psychosocial embarrassment affecting quality of life necessitating effective and reliable treatment. Unfortunately, treatment remains unsatisfactory due to limited efficacy, adverse effects and relapses after stopping treatment. Although chemical peels, laser and light therapies and dermabrasion may have utility, the evidence available for their efficacy is limited and they often cause post inflammatory hyperpigmentation particularly in individuals with darker skin types. Medical therapies remain mainstay in the management of melasma. The triple combination, hydroquinone 4%, tretinoin 0.05% and fluocinolone acetonide 0.01% (Triluma, Galderma, Ft. Worth Texas, often modified incorporating different corticosteroids) remains the only US FDA approved treatment for melasma and is the gold standard due its demonstrated efficacy across ethnicities. Oral tranexamic acid alone or in combination with other modalities has also shown significant efficacy. Several cosmeceuticals and botanical extracts used as skin lightening agents have been demonstrated to be useful. Physical sunscreens containing zinc oxide, iron oxide, titanium dioxide, and silicones provide photoprotective and camouflage effect. We propose that a multimodality approach to the treatment of melasma is the most effective treatment approach. This review is focused on the medical therapies for melasma.
... A study among Tunisian patients showed that more than half of the females reported sun exposure as a triggering factor of the disease, while most (84%) of the females reported sun exposure as an aggravating factor behind the disease. 14 Another study by R.R. Almuqati et al. 16 showed that relationships between sun exposure and sunburn, skin cancer, hyperpigmentation, and skin aging were reported by 94.8%, 78.8%, 79.2%, and 71.3%, respectively. ...
Article
Full-text available
Background: Melasma is an acquired state of hyperpigmentation that most commonly affects the face. The use of sunscreen is essential in melasma treatment. We sought to investigate patients' perspectives and behaviors toward sunscreen usage. Methods: A cross-sectional, hospital-based study targeted 418 melasma patients from May 2019 to May 2021. Data regarding socio-demographic characteristics and the knowledge, attitude, and behavior toward sunscreen and sun exposure were collected and analyzed. Furthermore, a complete clinical assessment was done. Results: The mean age of the patients was 35.4 ± 8.6 years. Melasma distribution was mostly Centro-facial (49.8%). The mean duration of the disease was 22.3 ± 11.6 months, with a mean Melasma Area and Severity Index (MASI) score of 18.6 ± 8.9. Only 170 patients believed that sun exposure played a role in their disease. Skin darkening was the most recognized effect of sun exposure by 92.9% of participants. 58.6% reported using sunscreen with a higher female predominance (p < 0.001), while males reported more broad-spectrum sunscreen usage (p < 0.001). The reason that was reported the most behind not using sunscreen was the high cost (94%). Conclusion: Our study showed a sound level of knowledge regarding the effects of sun exposure, and sunscreen advantages and disadvantages, with relatively inadequate translation into their attitudes and practices regarding sun-protective behaviors. The use of sunscreen among the patients was average in numbers with a higher female predominance.
... Melasma, a tan pigmentation spot formed on the face, is caused by a variety of factors. It primarily affects women with Fitzpatrick III-VI skin, certain genes, UV exposure, specific hormone levels, or those using drugs or cosmetics with specific ingredients [2][3][4][5][6]. Currently, treatment for melasma remains challenging. ...
Article
Full-text available
Background According to the literature, pigmentary disorders have a significantly negative impact on a person’s health-related quality of life. Moreover, among pigmentary disorders, incidence of melasma ranks high. The Melasma Area and Severity Index (MASI) is the scale that is generally used to evaluate a melasma-affected area and its severity. However, the relationship between the MASI and Melasma Quality of Life (MELASQoL) scores, as well as the impact of melasma on patients’ quality of life, remain unclear. Objectives To explore the influence of melasma on patients’ lives, analyze the relationship between the MASI and MELASQoL scores, and identify the factors that may be influencing the quality of life of patients with melasma. Methods Two reviewers independently searched four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for literature on quality of life of patients with melasma. In addition to an epidemiological study, a cross-sectional study, and validation studies, gray literature was also included. StataSE version 16 software was used for the meta-analysis. The score of each item on the MELASQoL scale was determined using a random-effects model. Results Fourteen studies with a total of 1398 melasma patients were included in the systematic review, four of which were eligible for meta-analysis. The relationship between the MELASQoL and MASI scores was found to be mixed. Five studies concluded that the MASI and MELASQoL scores were statistically correlated, while seven studies found no statistical correlation between the two. It is obvious that melasma causes emotional distress and has a negative impact on patients’ social lives. Patients were most bothered by the appearance of their skin condition. However, the MELASQoL score had no definite correlation with patient characteristics such as age, education levels, and history. Conclusion Melasma has a significant negative impact on patients’ quality of life. Thus, evaluating the quality of life of patients with melasma should not be ignored. Additionally, utilization of the MELASQoL scale should be considered in the care plan. Further studies with larger sample sizes are needed to confirm the relationship between melasma and quality of life.
... The usual sites are on the centrofacial region, cheeks and mandible. Melasma commonly affects dark/dusky skin but it can occur in every kind of skin [4,5,6]. Various patterns of melasma seen -Centrofacial: involves forehead, cheeks, upper lip, nose, chin and is the commonest. ...
Article
Background: Melasma refers to acquired hyper-pigmentary condition effecting skin. Owing to its multifactorial causation and chronicity, there is an increased need for new multimodality therapies to treat melasma more effectively and to prevent the side effects seen with the conventional modalities of treatment. Objectives: Compare efficacy of combining oral Tranexamic Acid and Azelaic Acid 15% with that of Oral Tranexamic Acid (TA) and Modified Kligman’s Formula. Also, to record any adverse effects of combining these agents. Methods: Patients having Melasma who will be coming to Dermatology OPD, AVBRH, Sawangi, Wardha, will be enrolled after considering the various inclusion and exclusion criteria. A detailed history will be asked, which will be followed by a cutaneous examination that includes the calculation of MASI (Melasma Area and Severity Index). One Group (A) - participants will receive - Oral 500 mg Tranexamic acid OD plus Modified Kligman’s Formula (fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2%) cream one time at night only. Second Group (B)- participants will receive - Oral 500 mg Tranexamic Acid OD plus Azelaic Acid 15% gel once daily at night only. Both groups will also receive Broad-spectrum sunscreen SPF-30 daily (3 hourly). Patients will be called for regular follow up at 4 weeks and 8 weeks (for early results). Clinical photos will be clicked at every follow-up visit and MASI score shall be doocumented. Expected Results: To analyze efficacy of combining Oral TA along with Azelaic Acid 15% and if it provides better results, we can avoid the undesirable side effects that are seen on prescribing the Modified Klingman’s Formula, in Melasma patients. Conclusion: This study will help us in analyzing efficacy of combining Oral TA with Azelaic Acid 15%, therefore will provide a newer treatment modality with lesser side effects and maybe better results than the gold standard- Modified Klingman’s Formula.
... This disorder, which is more prevalent in females and darker skin types, is predominantly attributed to ultraviolet (UV) exposure and hormonal influences. [1] Melasma is generally a clinical diagnosis consisting of symmetric hypermelanosis in three predominant facial patterns: centrofacial, malar, and mandibular. On the basis of histopathologic findings, three variants of melasma are identified: epidermal melasma, when the pigment is deposited in the basal and suprabasal layer; dermal melasma, when melanophages filled with melanin are found in the superficial and middle dermis; and mixed melasma, when findings of the two previous types of melasma are present. ...
Article
Full-text available
Background: Melasma is a commonly acquired, chronic, and relapsing disorder that results in symmetrical, brownish facial pigmentation. It is more common in women than in men, which generally starts between 20 and 40 years of age, and it can lead to considerable embarrassment and distress. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents. Microneedling has been described as a new technique to enhance the drug's transdermal penetration, and has also been reported to result in sustained long-term improvement of recalcitrant melasma. Aim: The aim of this article was to compare the therapeutic efficacy and safety of combined treatment of skin microneedling and depigmenting cream versus depigmenting cream alone in the treatment of melasma. Materials and methods: A prospective study was conducted with a sample size of 40 patients, with twenty in each of the treatment arms; 20 patients were treated with combined skin needling and depigmenting cream and 20 with depigmenting cream alone. The outcome was evaluated periodically for up to 2 months using the modified Melasma Area and Severity Index (MASI) score. Results: Significant reduction was observed in modified MASI score in the combined treatment, with P value <0.05. Conclusion: Combining microneedling with Kligman's regimen gives better results in melasma treatment compared to topical treatment alone.
... gave history of using sunblock. The UV radiation triggers DNA damage in the nuclei of keratinocytes, this leads to production of melanin by the melanocytes 23 . The UVA and UVB main radiations contribute to melanogenesis; however Infrared radiation and visible light have a low melanogenic potential 24 . ...
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OBJECTIVE: To assess self-medication in melasma cases by examining their reasons and consequences. METHODOLOGY: This descriptive cross-sectional study included 300 melasma cases were selected by convenience sampling from outdoor Dermatology and Medicine Department Rawal Institute of Health Science Islamabad (January-June 2018). Patients already under care of dermatologist and with severe systemic illness, also, patients with underlying endocrine disease or systemic conditions leading to hyper pigmentation, cases with drug induced pigmentation and receiving oral contraceptive pills were excluded. Demographic details, self-medication type, reasons, complications and alternative therapy were documented. Data analyzed by SPSS V-17 with significant p<0.05. RESULTS: Among 300 melasma cases, 227(75.6%) reported self-medication with 213(93.8%) females and 14(6.2%) males, mean age 30+5.7 years and melasma duration 3.55+3.6 years. Superficial melasma 156 (68.8%) and deep 64(28%). Sun-block used by 29(12.8%). Oral self-medication 15(6.6%), alternative medicine 70(30.8%), mud application 42(18.5%), whitening creams 149(65.6%) and therapy by beautician 136(60%). Hospital access lack in 14(6.2%), lack of money 7(3%), distrust on doctors 3 (13.2%), perceived as minor disease 176(77.5%). Reason for consultation was no improvement in 84 (37%), partial improvement 50(22%) and worsening 93(43%). Complications observed were acne in 91(40%), skin thinning 14(6.2%) and hirsutism 44(19.4%). Associations were acid peptic disease 21(9%), family history 28(12%) and pregnancy 8(3.5%). Mean expenditure was 4,160 rupees/month. CONCLUSION: Self-medication by whitening creams and therapy by beautician is frequent among melasma cases followed by herbal therapy, mud application, oral and topical medication. Delayed presentation and associated complications of self-medication i.e. acne, hirsutism, skin thinning, folliculitis and telangiectasias need to be addressed. Authors recommend sun-block and early dermatology consultation to prevent complications, recurrence and improve quality of life.
... Entre los factores de riesgo asociados a melasma se encuentran: el sexo femenino, estar entre la tercera y cuarta década de la vida 1 , embarazo 8 , uso de hormonas femeninas estrogénicas, progestagénicas o mixtas 9 y la radiación solar 10 . otros factores son: el componente genético 8 , el uso de algunos cosméticos derivados del petróleo, ciertas drogas como la fenitoína, el estrés emocional 9 e incluso la infección por clamidias 11 . ...
Article
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El melasma es un trastorno pigmentario, caracterizado por máculas color marrón oscuro en las mejillas, en el dorso nasal, la frente y el bozo. Se presenta con más frecuencia en las mujeres de mediana edad con desequilibrios hormonales. Es una entidad difícil de tratar. El uso de Láser Nd YAG modo Q-switched bajo la modalidad láser toning es en la actualidad una opción terapéutica. El objetivo es evaluar la eficacia del Láser Nd:YAG 1064nm en modo Qswitched en el tratamiento del melasma. Se estudiaron 165 pacientes femeninas entre 34 y 56 años de edad (media: 45 años) con diagnóstico clínico de melasma. Se utilizó Láser Nd YAG 1064 nm (Spectra VRM Laser Lutronics) en modo Q-switched (fluencias bajas 1-2 J/cm2 spot 8mm frecuencia 10 Hz, pases múltiples). Se realizaron ocho sesiones a razón de una semanal. Antes y luego del tratamiento se efectuó un registro fotográfico con el sistema VISIA (Complexion Analysis Canfield Científico) y se obtuvo un análisis cuantitativo por el sistema, de las imágenes del rostro (frontal y laterales). Después de un promedio de 6± 2 sesiones, el tono de la piel del grupo de pacientes mostró una mejoría significativa (p<0.005) en comparación con los valores obtenidos antes del tratamiento y cualitativamente se observó una mejoría en la textura de la piel. Todas las pacientes expresaron satisfacción con el tratamiento. El uso del modo Q-Switched del 1064 nm Nd: YAG láser fue efectivo en el tratamiento del melasma debido a que mejoró además la apariencia y calidad de la piel de las pacientes.
... [15] In a prospective study of 197 patients in Tunisia in 2010, aggravating factors of melasma were evaluated and sun exposure was accepted as the main aggravating factor. [16] UV-A and UV-B are the main radiation sources causing melanogenesis. The role of infrared radiation and visible light, which has a significantly low melanogenic potential, in the development and maintenance of melasma, is still uncertain. ...
... It's particularly more common in Fitzpatrick skin types IV and V with predominantly Centro facial pattern. 9 Measurement of QoL is of great importance in dermatology, as direct risk to life may not be caused by the disease, but emotional well-being and social life of the patient can be affected. 10 As a practicing clinician only the clinical aspect of dermatological disease is taken into consideration, however, studies have shown that adjunctive psychological stress assessment plays an important role in management of these conditions. ...
Article
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Introduction: Melasma is an acquired hyper melanosis that becomes more pronounced after sun exposure. Centro facial which is the commonest pattern followed by Malar and Mandibular are three clinical patterns of Melasma. Genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, contribute to the pathogenesis of melasma. Melasma may considerably have significant effect on quality of life of patients. Objectives: The present study was conducted to evaluate the effects of melasma in quality of life (QoL) in the form of DLQI (Dermatology Life Quality Index) and severity of melasma according to Melasma Area and Severity Index (MASI). Materials and Methods: This is a hospital based cross-sectional prospective study conducted in 193 Melasma patients in the Department of Dermatology, Venereology and Leprology, Gandaki Medical College and Teaching Hospital, Pokhara from November 2018 to November 2019. MASI score was calculated and the patients were provided with a Nepali version of DLQI to fill up. Results: This study included 193 patients. Mean age of patients with melasma was 29.4 ± 8.5 years with maximum reported age of 59 years. The Mean age of onset of disease was 26.5 years. The Mean age of onset of disease had little impact on DLQI. The mean DLQI score was 10.9 ± 5.9, thus indicating “very large effect on patient’s life”. The mean MASI score was 6.6 ± 5.2. It was found that there was no correlation between severity of disease and DLQI scores (p=0.317) Conclusion: Melasma commonly affected females during second and third decades of life. It had a very large effect on patient’s life as assessed by DLQI.
... Almost 75% of our patients were skin type IV; melasma incidence in darker skin types has been previously acknowledged. Family history has been found to be a risk factor of melasma (23) and over one-third of our patients gave positive family history, and our patient group included three pairs of sisters with melasma. ...
Article
Background: Melasma is a complex pigmentary disorder with challenging management. Objectives: Evaluation of efficacy of topical TXA versus Vitamin C (Vit C) with microneedling (MN) in melasma therapy. Materials and Methods: In 30 females with melasma, after 4 weeks of using Modified Kligman’s formula, the right side of face was treated with MN + TXA and the left with MN + Vit C for five biweekly sessions. Wood’s light, dermoscopy, melasma area and severity index (MASI), MASI malar right and malar left (MASIMR and MASIML), visual analogue score (VAS) and DLQI were evaluated at weeks 0, 4, 12 and 16. Results: Both MASIMR and MASIML decreased significantly (p <0.001). Both sides exhibited significant diminution in dark fine granules (p value <0.001), homogeneous pigmentation (p value =0.005) and pseudoreticular brown network (p value =0.028). However, telangiectasia significantly improved only on the TXA treated side (p = 0.002). DLQI improved significantly on both sides (p < 0.001). In some patients transformation of mixed to dermal melasma was depicted. Conclusion Microneedling followed by Vit C or TXA is successful in melasma management, the latter being advantageous vis-a-vis dermal vascularity and epidermal pigmentation. Dermoscopic evaluation appears crucial in choosing optimum treatment in each patient.
... 10 Similarly with Guinotet al. (Tunisian,2010) found 76% of the patients presented with centrofacialmelasma, while only 23% presented malar and 1% mandibular melasma. 16 Dharniet.al (India, 2018) was observed that out of the 80 patients, 38 (47.5%) patients had centrofacial pattern, 31 (38.75%) ...
Article
Background: Melasma is an acquired, irregularly patterned, light to dark-brown hypermelanosis, with symmetric distribution mostly over the face. Currently there is no published data about incidence of melasma in Indonesia. Methods: Retrospective study was conducted in patients with melasma from January 1, 2016 to December 31, 2018 in Dr. M. Djamil hospital padang, Indonesia. Results: Melasma was more prevalent in females (96.6%) and in Fitzpatrick skin phototypes IV (60 %) and III (40 %). Among 60 patients, centrofacialmelasma was most common (48.3 %), Family history (58.1%) and sun exposure exceeding 1 hour (61.3%) were among the factors contributing to melasma development. The incidences of melasma in 2016-2018 varied every year, the most affected was in female 44-64 years old, the most clinical type is Centrofacial, and epidermal type from Wood’s lamp examination. Conclusions: This population was characterized by: a high incidence in females, Fitzpatrick skin phototypes IV, diseasepresipitation by family history and sun exposure
... We found that the incriminated triggering factors were sunlight exposure (50%), pregnancy (95%), and oral contraceptive pills (29.4%). This was in agreement with the study carried out by Guinot et al. [14], where the main triggering factors were sunlight, pregnancy, and oral contraceptive pills in the same order. ...
Article
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Objective Tyrosinase is the rate‐limiting enzyme in melanogenesis. Thiamidol is the most potent inhibitor of human tyrosinase out of 50,000 tested compounds. In clinical studies, it was shown to improve facial hyperpigmentation, post‐inflammatory hyperpigmentation, and age spots significantly. To identify the optimal number of daily Thiamidol applications, we conducted a split‐face study comparing the efficacy and tolerability of four‐times with two‐times daily application. Subsequently, we evaluated the efficacy and tolerability of a typical face care regimen containing Thiamidol in a real‐world study. Methods The split‐face study was double‐blind, randomized, controlled, including two Thiamidol containing products (serum and day care SPF 30). The serum was applied twice‐daily on one half of the face, and the day care SPF30 twice‐daily on the whole face. The real‐world study was open‐label, observational, including three Thiamidol containing products (day care SPF 30 in the morning, serum and night care in the evening). In both studies, subjects with mild‐to‐moderate facial hyperpigmentation applied the products over 12 weeks. Assessments included clinical and subjective grading of hyperpigmentation, skin condition, hemi‐/modified MASI, chromameter, and clinical photography. Results In the split‐face study (n=34), hyperpigmentation, skin roughness, and hMASI improved all significantly (p<0.001) versus baseline, with first visible results after two weeks of twice‐daily application. The four‐times daily application led to significant improvement versus the two‐times daily application. In the real‐world study (n=83), all evaluated parameters, including skin condition and chromametry (n=30), improved significantly (p<0.001) in comparison to baseline and the corresponding preceding visits. The subjects judged the cosmetic properties of the products positively. In both studies the products were well tolerated. Conclusion Four‐times daily Thiamidol improves facial hyperpigmentation significantly more than two‐times daily application and is well tolerated by the subjects. The real‐world study with a typical face care regimen containing Thiamidol shows improvement of facial hyperpigmentation and confirms tolerability. Furthermore, the data provide evidence for the suitability of this three‐product Thiamidol regimen for day‐to‐day life.
Article
Melasma, also called ‘chloasma’, is a common skin condition of adults in which light to dark brown or grayish pigmentation develops, mainly on the face. Although it can affect both genders and any race, it is more common in women. Melasma is an acquired pigmentary disorder described as symmetrical blotchy or splotchy hyperpigmented macules and patches. The aim of this study was to investigate thyroid profile with anti TPO and iron, uric acid level, in male and female patients. It is a cross-sectional observational study done on 76 females and 25 male who were diagnosed with melasma and thyroid profile with anti TPO, serum iron and uric acid levels were measured. In our study females were more affected then males. In females Mean ± SD value of serum TSH (5.1±2.51) and anti-TPO (11.2±3.1) levels were increased when compared to males(4.9±2.54) and (9.2±1.9). Serum iron value was low in females (83.7±30) than males (90±29). All biochemical parameter were not significant but anti TPO and FT3 showed significant (P<0.001) in female with compared to male. Serum uric acid (3.56±0.77) and serum iron (83.7±30) Mean± SD value was low in melasma females than males which is not significant. Females Mean±SD value of T3 (1.30±0.62) and T4(6.8±1.9), FT4 (1.2±0.44) were non significance showed than compared to males and not significant to males T3 (1.33±0.66) and T4(7.1±1.6), FT4 (1.3±0.67) respectively. Melasma is more severe in females than males. Thyroid profile is not the accurate parameter but anti TPO, and iron level are predictive marker of melasma.
Article
Background: Chemical peelings are used on a wide scale in cosmetic field including melasma treatment. They often provide clinicians with flexibility in tailoring treatments according to patient needs and satisfaction. Objective: To evaluate safety and efficacy of chemical peeling as single agents in melasma management in patients with darker skin types. Methods: We included randomized controlled trials (RCTs) and prospective studies that assessed efficacy and safety of chemical peeling as single agents for facial melasma. An online bibliographic search was conducted, and data were extracted from the included studies. Results: Ten RCTs and three prospective comparative studies (No. of patients =478) were included. The overall effect estimate favored Glycolic acid (GA) over trichloroacetic acid peel in terms of melasma activity and severity index (MASI) (mean difference [MD] -1.89, 95% CI [-3.26, -0.52], p =0.007). On the other hand, the overall effect estimates did not favor GA over tretinoin (MD 0.53, 95% CI [-0.46, 1.52], p =0.3), vitamin C iontophoresis (MD 1.50, 95% CI [-0.50, 3.50], p =0.14), and amino fruit acid (MD 0.39, 95% CI [-0.64, 1.42], p =0.46) in terms of MASI. The overall effect estimates favored trichloroacetic acid peel (MD -5.30, 95% CI [-6.41, -4.19], p <0.001) and Jessner's solution (MD -3.20, 95% CI [-5.35, -1.05], p =0.004) over topical hydroquinone in terms of MASI. Conclusion: In conclusion, chemical peelings are effective as single agents for management of melasma in patients with darker skin types, with the use of topicals as maintenance treatment.
Article
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BACKGROUND: Melasma is a common chronic acquired hyper melanosis. It has significant impacts on appearance, psychosocial and emotional distress, hence reducing the quality of life of the affected patients. Melasma quality of life scale (MelasQoL) is a new quality of life (QoL) questionnaire consists of 10 questions, scored from 1 to 7, with higher index scores indicating poor QoL. The severity of melasma can be assessed by the Melasma Area and Severity Index (MASI) score. AIM: We aimed to determine the correlation between the severity of melasma (MASI score) and quality of life. MATERIAL AND METHODS: This was a cross-sectional analytic study involving 30 subjects with melasma. The diagnosis was made based on history, clinical features and by Wood’s lamp examination. MASI score was determined to assess the severity of melasma. Subjects answered 10 items of MelasQol questionnaire. All collected data were processed and statistically analysed by Spearman correlation test to determine the association of MASI score with MelasQoL. Association of quality of life with clinical pattern and depth of lesion were analysed by Mann Whitney test. RESULTS: There was no significant correlation between MASI score and MelasQoL (p = 0.797; r = 0.049). Likewise, there was no association of quality of life with clinical pattern type (p = 0.12) and depth of lesion (p = 0.92). CONCLUSION: There was no significant correlation between the MASI score and quality of life.
Article
Melasma is a common disorder of hyperpigmentation that affects populations globally and can adversely affect quality of life. Topical therapies—including hydroquinone and nonhydroquinone‐containing formulations—play a central role in the management of melasma. A literature review was conducted using PubMed and Google Scholar. Search keywords included a combination of the following: “melasma,” “chloasma,” and “topical treatment.” We identified and included seminal and high‐quality peer‐reviewed publications, systematic reviews, randomized controlled trials, case series, case reports, consensus statements, and expert opinions. Topical therapies are widely used for the treatment of melasma. Triple combination cream containing hydroquinone, fluocinolone, and tretinoin is the most studied formulation with the strongest evidence among treatment options. Numerous other prescription‐based and nonprescription topical agents, including a growing list of cosmeceuticals, have been used in the treatment of melasma, albeit in smaller studies. A growing range of topical agents is available for the treatment of melasma. While larger, more robust studies are warranted, nonhydroquinone cosmeceuticals may be useful adjuncts or alternatives to the gold standard of triple‐combination hydroquinone cream.
Article
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The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.
Article
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Complete endocrinologic evaluation of 9 women (ages 24-41) with idiopathic melasma (melasma not associated with pregnancy nor ingestion of oral contraceptives) was performed and compared to age- and sex-matched normal controls. Serum cortisol, adrenocorticotropin, plasma immunoreactive alpha and beta melanocyte-stimulating hormones, luteinizing hormone, follicular-stimulating hormone, estradiol and progesterone levels were performed in the basal state. Additionally, total T4, T3RU, FTI, prolactin, 2-h postprandial blood sugar, and 24-h urine for 17-hydroxysteroids and 17-ketosteroids were done and found to be normal. The melasma patients presented statistically significant increased levels of LH (p less than 0.001) and lower levels of serum estradiol (p less than 0.025) than normal controls. It is proposed that these hormonal alterations may represent subclinical evidence of a mild ovarian dysfunction which may underlie the pathogenesis of some cases of idiopathic melasma.
Article
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Treatment of melasma involves the use of a range of topical depigmenting agents and physical therapies. Varying degrees of success have been achieved with these therapies. The Pigmentary Disorders Academy (PDA) undertook to evaluate the clinical efficacy of the different treatments of melasma in order to generate a consensus statement on its management. Clinical papers published during the past 20 years were identified through MEDLINE searches and methodology and outcome assessed according to guidelines adapted from the US Preventive Services Task Force (USPSTF). The consensus of the group was that first-line therapy for melasma should consist of effective topical therapies, mainly fixed triple combinations. Where patients have either sensitivity to the ingredients or a triple combination therapy is unavailable, other compounds with dual ingredients (hydroquinone plus glycolic acid) or single agents (4% hydroquinone, 0.1% retinoic acid, or 20% azelaic acid) may be considered as an alternative. In patients who failed to respond to therapy, options for second-line therapy include peels either alone or in combination with topical therapy. Some patients will require therapy to maintain remission status and a combination of topical therapies should be considered. Lasers should rarely be used in the treatment of melasma and, if applied, skin type should be taken into account.
Article
Objective To better understand melasma, a review of its etiologic factors, classification, pathogenesis, and treatment was undertaken. Methods Articles discussing the above aspects of melasma were used to demonstrate what is currently known about the disease and how to treat it. Results Melasma is associated with many etiologic factors, most importantly, sun exposure. It occurs in three distributions and has four reported patterns of pigmentation. Among the many differences between melasma and normal skin, melasma skin contains increased melanin, melanocytes, and melanosomes, as well as increased synthesis of tyrosinase. Its pathogenesis remains largely unknown. Treatment consists of phenolic and nonphenolic depigmenting agents, chemical peels, lasers, and dermabrasion. Conclusion Melasma is a common skin disorder. Although melasma has been studied, its pathogenesis remains largely unknown and its treatment is still met with difficulty. Randomized controlled trials involving larger numbers of patients and comparing treatments, as well as studying combination therapies, would be beneficial.
Article
Background and Design: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. Results: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution.Conclusions: This controlled study demonstrates that topical 0.1% tretinoin lightens melasma in black patients, with only mild side effects.(Arch Dermatol. 1994;130:727-733)
Book
From the reviews of the First Edition."An interesting, useful, and well-written book on logistic regression models . . . Hosmer and Lemeshow have used very little mathematics, have presented difficult concepts heuristically and through illustrative examples, and have included references."—Choice"Well written, clearly organized, and comprehensive . . . the authors carefully walk the reader through the estimation of interpretation of coefficients from a wide variety of logistic regression models . . . their careful explication of the quantitative re-expression of coefficients from these various models is excellent."—Contemporary Sociology"An extremely well-written book that will certainly prove an invaluable acquisition to the practicing statistician who finds other literature on analysis of discrete data hard to follow or heavily theoretical."—The StatisticianIn this revised and updated edition of their popular book, David Hosmer and Stanley Lemeshow continue to provide an amazingly accessible introduction to the logistic regression model while incorporating advances of the last decade, including a variety of software packages for the analysis of data sets. Hosmer and Lemeshow extend the discussion from biostatistics and epidemiology to cutting-edge applications in data mining and machine learning, guiding readers step-by-step through the use of modeling techniques for dichotomous data in diverse fields. Ample new topics and expanded discussions of existing material are accompanied by a wealth of real-world examples-with extensive data sets available over the Internet.
Article
In exploratory studies, researchers often include as many variables as possible to ensure that no relevant variables will be omitted. The resulting data matrices can sometimes be large and difficult to analyze, particularly if the level of correlation among the variables is high. In techniques such as multiple regression and discriminant analysis, variable selection procedures can be employed as a data reduction technique; however this method can result in the loss of one or more important dimensions. An alternative approach is to use all of the variables in X to obtain a smaller set of new variables that can be used to approximate X. The new variables are called principal components or factors and are designed to carry most of the information in the columns of X. The higher the level of correlation among the columns of X the fewer the number of new variables required. The techniques of principal components analysis and factor analysis are examples of data reduction techniques.
Article
Background: Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sunexposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Observations: Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. Conclusions: In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.(Arch Dermatol. 1995;131:1453-1457)
Article
Complete endocrinologic evaluation of 9 women (ages 24-41) with idiopathic melasma (melasma not associated with pregnancy nor ingestion of oral contraceptives) was performed and compared to age- and sex-matched normal controls. Serum cortisol, adrenocorticotropin, plasma immunoreactive α and β melanocyte- stimulating hormones, luteinizing hormone, follicular- stimulating hormone, estradiol and progesterone levels were performed in the basal state. Additionally, total T,4, T3RU, FTI, prolactin, 2-h postprandial blood sugar, and 24-h urine for 17-hydroxysteroids and 17-ketosteroids were done and found to be normal. The melasma patients presented statistically significant increased levels of LH (p < 0.001) and lower levels of serum estradiol (p < 0.025) than normal controls. It is proposed that these hormonal alterations may represent subclinical evidence of a mild ovarian dysfunction which may underlie the pathogenesis of some cases of idiopathic melasma.
Article
Melasma is characterized by a facial hypermelanosis of light to dark brown color, being more common in women of Hispanic origin. In this study, 27 men with melasma were evaluated clinically and histologically to compare their features with those of previous studies. Three patterns of localization were recognized, namely, centrofacial, malar, and mandibular. On the basis of Wood's light examination, an epidermal, a dermal, and a mixed type were identified. Epidermal hyperpigmentation only and epidermal and dermal hyperpigmentation were found in histologic analysis of the cases. Significant etiologic factors included exposure to sunlight in 66.6% as well as a familial predisposition in 70.4% of the cases. This study demonstrated that melasma in men shares the same clinicohistologic characteristics as in women, but hormonal factors do not seem to play major significant role.
Article
Melasma is localized hyperpigmentation over the forehead, upper lips, cheeks, and chin. In this study, evidence suggesting an association between autoimmune thyroid disorders and melasma and the relationship of thyroid disorders to the origin of melasma is presented. A total of 108 nonpregnant women, aged 20-56 yr, were divided into 2 groups for the purpose of this study: 1) melasma, 84 patients; 2) control group, 24 patients from the Dermatology Clinic matched for age and sex. Microsomal thyroid autoantibodies (MCHA) were sought in all subjects. TRH-TSH tests were performed in patients with melasma and in those women with goiter and/or positive MCHA tests from the control group. Studies were completed with serum T4, T3, and antithyroglobulin antibody (TGHA) measurements in all patients with thyroid abnormalities. In patients with melasma, the frequency of thyroid disorders (58.3%) was 4 times greater than in the control group. The MCHA-negative patients had 1) simple goiter (13.1%), 2) Plummer's disease (2.4%), and 3) TSH hyperresponse to TRH in nongoitrous patients (10.7%). Patients with positive MCHA tests (32.1%) were divided into 2 subgroups. One comprised those women with an apparently normal thyroid gland and thyroid function (n = 7), while the other included all patients with goiter and/or subclinical hypothyroidism (n = 20). Regarding the origin of the melasma, it was found that 70% of women who developed melasma during pregnancy or while using oral contraceptives had thyroid abnormalities compared to 39.4% of patients with idiopathic melasma. Subjects from the control group had a 12.5% incidence of thyroid abnormalities, and only 8.3% had positive MCHA. Estrogen, progesterone, or both could be the triggering factor in the development of melasma in women who have a particular predisposition toward both melasma and thyroid autoimmunity. Patients with idiopathic melasma had a lower frequency of thyroid abnormalities, suggesting that there may be different genetic patterns linked to autoimmune thyroid disease. We conclude that there is a true association between thyroid autoimmunity and melasma, mostly in women whose melasma develops during pregnancy or after ingestion of oral contraceptive drugs.
Article
Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sun-exposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications. Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established. In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.
Article
Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the tretinoin group compared with the vehicle group. Side effects were limited to a mild "retinoid dermatitis" occurring in 67% of tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution. This controlled study demonstrates that topical 0.1% tretinoin lightens melasma in black patients, with only mild side effects.
Article
Clinical assessments of photodamage are based upon a subjective evaluation of characteristic features such as wrinkling and pigmentary change, and are influenced by inter-observer differences in grading criteria. In an effort to standardize the grading of photodamage severity, we have developed a six-point photographic scale in which each of the six grades of overall photodamage severity is depicted by three photographs. The use of three photographs to portray each grade illustrates the diversity and range of manifestations within each grade. This photographic scale was tested by two groups of dermatologists, who used it on two occasions to grade the overall photodamage severity of a single group of female Caucasian subjects. Results indicate high inter-observer agreement, with chance-corrected agreement ranging from 0.44 to 0.63 and from 0.54 to 0.76 on the first and second occasions, respectively. Intra-observer repeatability was high, with chance-corrected agreement ranging from 0.56 to 0.78. Inter- and intra-observer differences were within one category in nearly all cases. Similar grades were assigned by dermatologists with and without experience in treating photodamaged patients. We conclude that application of this scale results in consistent and reproducible clinical evaluations of overall photodamage severity in Caucasian subjects. The scale may be useful in categorizing subjects for epidemiological studies, or in selecting patients for clinical trials.
Article
The endocrine, metabolic, and immunologic changes during pregnancy give rise to a number of physiologic cutaneous changes. We evaluated 140 pregnant women to determine the pattern of pregnancy-induced physiologic skin changes in our community. The various changes observed include: increased pigmentation (90.7%), striae (77.1%), edema (48.5), melasma (46.4%), vascular changes (34.2%), and others. Pigmentary changes were the most common finding, whereas the incidence of vascular changes was quite low (p < 0.01).
Article
Melasma in men is much less common than in women. In the present communication, we evaluated circulating levels of LH, FSH, and testosterone in 15 men with idiopathic melasma. When compared with eleven age matched control men, the circulating LH was significantly higher and testosterone was markedly low in the melasmic men. We conclude that male melasma involves subtle testicular resistance.
Article
Photoprotection with sunscreens is recommended in hyperpigmentation, particularly in pregnancy-related form. The aim of this study was to evaluate the use of sunscreens in pregnant women and to determine whether melasma was correlated to sunscreen use. Four hundred and fifteen pregnant women were surveyed by a standardized questionnaire on the presence of melasma and their use of sunscreens. The study took place in Casablanca, Morocco, in two public maternity hospitals and two private gynaecologic centres, from April 1999 to July 1999, during antenatal consultations. The mean age of the 415 pregnant women was 29 +/- 6 years. One hundred and fifty-one women (37 p. 100) had a melasma and 72 (17 p. 100) used a sunscreen at their inclusion in the study. Women with melasma used sunscreens in 18.8 p. 100 and the others in 16.6 p. 100. Users of sunscreens differed from non-users in their higher level of instruction, professional activity, presentation in private practice and of urban origin. This study showed a low incidence of sunscreen use in our population of pregnant women. Melasma wasn't a reason for using sunscreens. However, access to medical information, especially to photoprotection advice, and the financial possibility of buying the product led to larger use of sunscreens. Up to now no study has confirmed that sunscreens can prevent melasma in dark phototype women with pregnancy. It would therefore be difficult to recommend them to pregnant women.
Article
PIP: The incidence of cutaneous effects of oral contraceptives (OCs) is estimated at 2.7-5%. Secondary effects directly attributable to the hormonal action of OCs include melasma, acne and hyperseborrhea, alopecia, and cutaneous lesions of vascular origin. Melasma or chloasma accounts for about 2/3 of all cutaneous side effects of OCs. It appears from 1 month-3 years after the start of OC use, its frequency increasing with dose and duration of use. Pigmentation appears to accentuate the symptoms in brunettes rather than predisposing them to melasma. Exposure to the sun plays a certain role, but use of a low dose OC and effective sun protection are not enough to reverse the pigmentation. These melasmas regress more slowly than after pregnancy and many remain definitive. The influence of OCs on acne is variable, with some OCs provoking sebaceous hypersecretion and some improving acne enough to be used for treatment. For the therapeutic effect to be observed, the estrogen dose must be sufficient to offset the androgenic effect of the progestin. Combined pills containing the strong antiandrogen cyproterone acetate should control acne if other, less androgenic progestins fail. Alopecia is a very rare effect of OCs and its appearance may even reflect simple coincidence. Vascular complications of combined OCs are dependent on estrogens and may include such manifestations as telangiectasias, angiomas, and livedo reticularis. Some secondary cutaneous effects are probably not due to a hormonal influence. They are less well known than the direct hormonal effects, and publications concerning the often detail isolated observations that are difficult to interpret. Reactions of hypersensitivity or allergy to combined OCs may include urticaria and eczema. A history of OC use should be sought in all women presenting with erythema nodosum and the OCs should be discontinued. Pruritus and jaundice may be observed in 1 OC user in 100,000. They indicate a cholestatic hepatitis for which estrogens are responsible. Most patients developing the condition have already had pruritus or jaundice during pregnancy; such a history contraindicates OC use. Several dermatological and systemic disorders are aggravated by OC use. Hereditary angioedema, herpes gestationis, porphyries, and systemic lupus erythematosus are exacerbated by OC use. The role of OCs in malignant melanomas remains controversial.
Article
To better understand melasma, a review of its etiologic factors, classification, pathogenesis, and treatment was undertaken. Articles discussing the above aspects of melasma were used to demonstrate what is currently known about the disease and how to treat it. Melasma is associated with many etiologic factors, most importantly, sun exposure. It occurs in three distributions and has four reported patterns of pigmentation. Among the many differences between melasma and normal skin, melasma skin contains increased melanin, melanocytes, and melanosomes, as well as increased synthesis of tyrosinase. Its pathogenesis remains largely unknown. Treatment consists of phenolic and nonphenolic depigmenting agents, chemical peels, lasers, and dermabrasion. Melasma is a common skin disorder. Although melasma has been studied, its pathogenesis remains largely unknown and its treatment is still met with difficulty. Randomized controlled trials involving larger numbers of patients and comparing treatments, as well as studying combination therapies, would be beneficial.
Article
Melasma is an acquired hypermelanosis of the face. There is little information on its prevalence during pregnancy in Iran. Objective To determine the prevalence and awareness of melasma during pregnancy at the Shahed University Hospitals of Tehran, Iran. A cross-sectional study was carried out by clinical examination and questionnaire on 400 pregnant women. The prevalence of melasma was 15.8%[95% confidence interval (CI) 12.3-19.4]. Malar pattern was seen in 65.9% of cases, whereas 33.8% of the patients had a centrofacial pattern. No case with a mandibular pattern was found. Positive family history of melasma was present in 54.7% of the cases. There was a statistically significant relation between melasma and ethnicity, phototype and grade of parity. However, no significant relation was observed between melasma and use of sunscreens, history of thyroid or liver disorders, trimester of pregnancy or phenotype (eye and hair color). 11.3% of the patients declared that they have developed melasma after using OCP Oral Contraception. Patients had little awareness of the etiology of melasma. In fact, 68.8% of the patients had no knowledge of its etiology. The effective factors or etiologies for melasma were stated as: 14.5% pregnancy, 9.8% sun exposure, 4.9% liver disorders, 4.9% nutrition and 1.6% sex of newborn. Our study confirms that melasma is common among pregnant women in Tehran, Iran. They had a low level of awareness of the etiology of melasma. There is a need for educational programs on the etiology and prevention of melasma in Iranian women.
Article
This study aimed to examine the frequency of self-assessed facial skin sensitivity and its different patterns, and the relationship with gender and sun sensitivity in a general adult population. A standardized 11-item questionnaire investigating reactions experienced during the past year was developed. The questions explored different patterns of skin sensitivity: pattern I (blushing related to vascular reactivity), pattern II (skin reactions to certain environmental conditions), pattern III (skin reactions after substance contact), and for women pattern IV ('breakout of spots' related to menstrual cycle). Additional items were addressed for women and men, including sun sensitivity. The questionnaire was administered to a large middle-aged population involved in the 'Supplément en Vitamines et Minéraux Antioxydants' (SU.VI.MAX) cohort. Sensitive facial skin was reported by 61% of the women (n = 5074) and 32% of the men (n = 3448), and the frequency decreased with age. The frequency of patterns I, II and III was greater for women (78, 72 and 58%, respectively) than for men (56, 48 and 28%) of comparable classes of age. The frequency of pattern IV was reported by 49% of premenopausal women, and skin reactions after shaving by 41% of the men. Sun sensitivity was found to be a major component of skin sensitivity. Factor analysis showed that individuals with fair phototype frequently evoked reactions associated with pattern I, and skin redness and burning sensations were related to certain environmental conditions (pattern II). Skin sensitivity is a common concern that declines with age and is relevant for men as well as for women.
Article
Latin-Americans have a heterogeneous ancestry that is defined by their place of domicile, while Hispanics are defined as those persons of Spanish descent. These two groups have a diverse range of skin phototypes and pigmentation and are prone to an increased incidence of melasma and post-inflammatory hyperpigmentation. Little research has been conducted to evaluate the frequency, course, effects, tolerability and treatment response of skin diseases in Hispanic and Latin-American populations. From the limited data that are available it is considered that the treatment of melasma in these two groups does not differ from the general population. First-line therapy of melasma should consist of effective topical therapies, mainly a fixed triple combination of hydroquinone, retinoic acid and fluocinolone acetonide. Where patients have either sensitivity or triple combination therapy is unavailable, other compounds with dual ingredients may be considered as an alternative. Options for second-line therapy include peels either alone or in combination with topical therapy. Lasers should rarely be used in the treatment of melasma and then only as third-line therapy in cases of melasma which is resistant to all other therapies. If applied, skin type must be taken into account. Irritation and sensitivity can be a concern in darker-skinned Hispanic patients and for this reason, the risk of post-inflammatory hyperpigmentation (PIH) following treatment should be considered.
Article
Melasma (cloasma) is a typical hypermelanosis and a common dermatologic skin disease that involves sun-exposed areas of the skin. It mostly affects women of reproductive age. Solar and ultraviolet exposure are the most crucial etiologic factors. Pregnancy, certain endocrine disorders and hormonal treatments, cosmetics, phototoxic drugs, and antiseizure medications are well-known inducing and exacerbating factors. A classification of melasma is based on Wood's light examination, classifying it in four major clinical types and patterns: epidermal, dermal, mixed, and indeterminate. Different treatment options are currently available for melasma. The choice of proper treatment should take into account the type of melasma to be treated, the skin complexion of the patient, possible previous treatments, the expectations and compliance of the patient, and the season in which the treatment is started.
Article
Melasma is an acquired hypermelanosis on sun-exposed areas. Its pathogenesis has not been clearly elucidated. Using histochemistry (Giemsa, Verhoeff-van Gieson and Fontana-Masson staining), we evaluated melasma lesions and compared them with nonlesional skin. Skin samples were obtained from lesional and nonlesional facial skin of 27 patients with melasma, and biopsies were also taken from normal control subjects. Mast cells and solar elastosis areas were evaluated using a computer-assisted image-analysis program. Lesional skin had abundant elastotic material compared with nonaffected skin (13.3 +/- 2.8% vs. 10.2 +/- 2.9%, P < 0.001). Mast cells were more prominent in the elastotic areas of melasma skin (173 +/- 57% vs. 145 +/- 57%, P = 0.04). Melasma could be a result of a cumulative sun exposure, in a microenvironment of cutaneous photoageing in which inflammatory cells, particularly mast cells, play a key role.
Soleil et peau [Sun and skin]
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