Melasma Article

Question 1

Melasma pathophysiology

Answer 1

Aka cholesma or mask of pregnancy

Acquired skin pegment condition - symmetrical. Melanin

Aka chloasma or mask of pregnancy.

Usually face forewarms and back

Prevalence 1%

Mostly fitz III-V, women, 20-40yrs

Disorder of photoaging.

Often has psychosocial impact.

Question 2

Risk factors for melasma

Answer 2

Women
20-40
Fitz III-V
Cumulative sun exposure/UV
FHx
Hormonal - COCP, pregnancy, implants.
Forearms - estrogen replacement therapy.
Perfumed soaps and cosmetics
Heat exposure - cooking fires.
Thyroid disease.
Medications - antiepileptics, psychotics, cytotoxic

Question 3

Patterns of melasma

Answer 3

50-80% centrofacial - spares philtrum - cheeks, nose, forehead, upper lip.
Malar
Mandibular pattern
Extrafacial - variable.

Epi or dermal

Inflamed forms of melasma - erythrosis pigmentosa faciei

Question 4

Diagnosis

Answer 4

Wood’s lamp
Biopsy
Clinical

Question 5

DDx melasma

Answer 5

Acanthosis nigricans - malar
Actinic lichen planus
Discoid lupus
Medication induced hyperpigmentstion
Ephelides - freckles
Frictional melanosis
Naevus of Ota
Post inflamm hyperpig
Solar lentigo

Question 6

Treatment

Answer 6

Fhx, disease>2yrs and fitz 3-5 have poor prognosis.

Hydroquinone 2-5% cream nocte 2-4 months
Azelaic, kojic, tranexemic acid
Kligmans’s formula - hydroquinone, tretinoin and dexamethasone.
Strict sun avoidance.
Oral TXA

Chemical peels and lasers - risk of exacebation

Intense pulsed light. - risk relapse and may develop resistance

Cosmetic camoflage