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Melasma/Chloasma
Published in Charles Theisler, Adjuvant Medical Care, 2023
Zinc Sulfate or Ascorbic Acid: Twenty melasma patients between the ages of 25 and 54 were studied. Patients received treatment with either 10% zinc sulfate or 10% L-ascorbic acid applied once daily. After two months of treatment there was significant improvement of melasma with both treatments. Minimal side effects were found with zinc sulfate.1
Dermatologic diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Holly Edmonds, Dana Ward, Ann G. Martin, Susana Leal-Khouri
Melasma (chloasma), or the “mask of pregnancy,” presents as blotchy, irregularly shaped, usually sharply demarcated patches of light to dark brown pigmentation of the face. It occurs in greater than 50%, with some studies reporting up to 75%, of pregnant women and in up to 34% of women taking oral contraceptives (14,15). Melasma usually begins during the second trimester and is more common in dark-skinned (skin types IV–VI) women (16). The most commonly affected sites are the nose and cheeks followed by the upper lips, forehead, chin, and eyebrows (17). Three clinical patterns exist, which can be distinguishable by examination with the Wood’s lamp. The causative agent for melasma is unknown. Contributing factors, aside from pregnancy and oral contraceptives, include genetics, skin type, exposure to UV radiation, nutrition, hepatic diseases, thyroid dysfunction, drugs, and cosmetics (16). Preventive measures such as avoidance of sun, usage of broad-spectrum sunscreens, and non-allergenic cosmetics are recommended. Treatment is frequently deferred until after delivery, since gestational melasma usually regresses within a year postpartum but may persist in less than 10% of patients (11). If melasma does persist, treatment options (in addition to consistent daily use of broad-spectrum SPF 30 sunscreen and sun protective hats) include topical hydroquinone products, or hydroquinone in combination with tretinoin and topical steroid creams, azelaic acid topical preparations, laser therapy, and chemical peels.
Aesthetic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Melasma may be caused in part by hormones such as thyroid hormones, MSH from stress as well as UVL. The dyspigmentation is due to the presence of more cells that are more active; a Wood’s lamp enhances epidermal pigment, but not dermal (which tends to be blue/black).
Fractional erbium:YAG laser (2940 nm) plus topical hydroquinone compared to intradermal tranexamic acid plus topical hydroquinone for the treatment of refractory melasma: a randomized controlled trial
Published in Journal of Dermatological Treatment, 2022
Fatemeh Mokhtari, Bahareh Bahrami, Gita Faghihi, Ali Asilian, Fariba Iraji
Melasma is a chronic acquired condition characterized by grayish-brown macules and patches with a distinct border on the face (1). The disease is more common in light brown skin types, particularly in Latin America, the Middle East, and Asia, and is more common in women who account for more than 90% of the cases (2). Although the exact pathophysiology of melasma is unknown, several factors are known to play a role, including but not limited to genetics, exposure to UV, pregnancy, oral contraceptives, hormone therapy, thyroid disorders, anticonvulsants, and phototoxic substances (3,4). Melasma is associated with epidermal hyperpigmentation, poor basement membrane, vascular proliferation, and increased mast cell proliferation. Evidence suggests that melanocytes are not the only cells involved in melasma, and other factors likely at play in the development and recurrence of melasma. Identification of these factors can lead to more effective treatments for melasma and facilitate the prevention of recurrences (5).
Melasma treatment: a systematic review
Published in Journal of Dermatological Treatment, 2022
Nicoleta Neagu, Claudio Conforti, Marina Agozzino, Giovanni Francesco Marangi, Silviu Horia Morariu, Giovanni Pellacani, Paolo Persichetti, Domenico Piccolo, Francesco Segreto, Iris Zalaudek, Caterina Dianzani
Topical treatments have been the mainstay of melasma treatment. Photoprotection is the most important and it has been used as an adjuvant to other melasma treatments, since both UV and visible light can cause sustained hyperpigmentation in all skin types. Hydroquinone has been considered a first-line treatment for melasma and triple combination creams containing hydroquinone have become increasingly popular, as they yielded superior results. Kligman formula was the first TCC, containing HQ 5%, tretinoin 0.1% and dexamethasone 0.1%. The most recent TCC is Tri‐Luma, which contains HQ 4%, tretinoin 0.05%, 0.1% fluocinolone acetonide and is FDA‐approved in USA for the treatment of melisma (103). Mild erythema, burning sensation, dryness, pruritus and scaling have been most frequently reported after topical HQ treatment (53,54,62,64,65).
Efficacy of a laser with a pulse duration of 300 ps in skin rejuvenation and treatment of pigmentation disorders in Asians: a series of four cases
Published in Journal of Cosmetic and Laser Therapy, 2021
Jie Hoon Kim, Soo Eun Jung, Yun Hwa Park
A 38-year-old woman visited our clinic with complaints of light-brown-colored, poorly demarcated pigmented patches on both cheeks (Figure 4a). She had not received any treatment with topical agents or laser/light devices. After examining the pigmented lesions, we made a clinical diagnosis of melasma. The patient then underwent 1,064-nm picosecond Nd:YAG laser treatment. Without applying any topical anesthetics, using a PICOHI device (Hironic Corp.), several pulses of the 1,064-nm picosecond Nd:YAG laser were delivered to the pigmented lesions with the parameters set at a spot size of 10 mm (collimate handpiece), fluence of 0.3–0.4 J/cm2, and pulse rate of 10 Hz using a sliding and circular technique until mild erythema appeared. She underwent treatment every 2 weeks for a total of 12 treatments. Immediately after treatment, an ice pack was applied to cool the treated area; no prophylactic topical corticosteroids and antibiotics were prescribed. The patient was advised to avoid excessive exposure to sunlight and to apply broad-spectrum sunscreens during the treatment period. After laser treatment, the melasma became brighter without notable side effects (Figure 4b).