Cases Of Melasma Research Articles

Therapeutic Effect of Dermapen with PRP versus Dermapen with Tranexamic Acid In Melasma Cases

Therapeutic Effect of Dermapen with PRP versus Dermapen with Tranexamic Acid In Melasma Cases

Treatment of Melasma Cases by Oral Tranexamic Acid: A Randomized Control Trial

Introduction: Melasma is a great challengefor a dermatologist as its treatment is unsatisfactory and recurrence is high.Treatment of melasma using oral tranexamic acid is a novel concept.
 Objectives: To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma.
 Materials and Methods: This prospective, interventional, randomized controlled trial was conducted among 130 melasma patients in the Department of Dermatology, Combined Military Hospital, Cumilla from June 2016 to June 2017. The patients were divided into two groups consisting of 65 patients each. The first group (Group A) was given routine treatment measures and oral Tranexamic Acid while the second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed during the course of treatment. The response was evaluated on the basis of Melasma Assessment Severity Index (MASI).
 Results: Astatistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8th and 12th weeks was observed among group A patents (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; (p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later).
 Conclusion: Oral Tranexamic acid provides rapid and sustained improvement in the treatment of melasma.
 Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 148-151

Comparative Study between the Efficacy of Intradermal Injection and Oral Administration of Tranexamic Acid in Treatment of Melasma

Melasma is an acquired hypermelanosis characterized by light to dark-brown macules and patches on sun-exposed areas. Most cases of melasma occur in women in the reproductive age with darker skin types, but all ages, races, and skin colours may be affected, Tranexamic acid is an antiplasminogen agent with well-documented efficacy against melasma. comparison of the efficacy and safety of intradermal injection and systemic administration of tranexamic acid in treatment of melasma. 40 female patients complaining of melasma were divided randomly into two groups, group A and B. mMASI score before and after treatment did not differ significantly between both groups . The response to the treatment was best in group A who was received intradermal injection(4mg/ml)TXA, followed by group B who was received oral TXA in a dose of 250 mg twice daily for 3 months. In group A, there was excellent response was detected in 6 patients (30%), good response was detected in 6 patients (30%), moderat response was detected in 5 patients (20%), mild response was detected in 1 patient (5%) and no response was detected in 2 patient (10%). In group B, excellent response was detected in 0 patients (0%) good response was detected in 1 patients (5%), moderat response was detected in 12 patients (60%), mild response was detected in 3 patient (15%) and no response was detected in 4patient (20%). Tranexamic acid may be a new treatment option for melasma. It is a safe, well-tolerated and effective treatment method.

Etiological profile of pyodermas in a tertiary care hospital in North-East India and their antibiotic sensitivity pattern

<p class="abstract"><strong>Background:</strong> Hypermelanoses involving predominantly the face and the neck is relatively common and often presents a complex diagnostic problem. The present study was done in the study population of 500 patients of facial pigmentation, attending the skin outpatient department in AarupadaiVeedu Medical College and Hospital from October 2015 to September 2017. Aim and objective of the study was to study various clinical patterns of facial pigmentation, their clinical characteristics, their association with other pigmentary disorders and to evaluate the different etiotogical and precipitating factors.</p><p class="abstract"><strong>Methods:</strong> In this study, a special proforma was prepared. Patients were thoroughly interviewed and examined to find out dermatological and systemic diseases and they were subjected to investigations to evaluate different etiological factors and diagnose the clinical type of facial pigmentation.<strong></strong></p><p class="abstract"><strong>Results:</strong> The present study showed a strong female preponderance. Among the total study population there were 55% cases of melasma, 20% cases of Riehls melanosis, 10% cases of periorbital pigmentation and 5% of miscellaneous causes.</p><p class="abstract"><strong>Conclusions:</strong> Facial pigmentation was commonly seen in the females. 21-30 years age group was the most commonly affected age group in all types of facial pigmentation. Melasma, Riehls melanosis and periorbital pigmentation were the most common clinical types of facial pigmentation observed.</p>

Clinico-epidemiological study of facial hyper-melanoses among patients attending dermatology outpatient department at a tertiary care hospital at Pondicherry

<p class="abstract"><strong>Background:</strong> Hypermelanoses involving predominantly the face and the neck is relatively common and often presents a complex diagnostic problem. The present study titled “Clinico-epidemiological study of facial hyperpigmentation” was done in the study population of 500 patients of facial pigmentation, attending the skin outpatient department in AarupadaiVeedu Medical College and Hospital from October 2015 to September 2017.</p><p class="abstract"><strong>Methods:</strong> Aim and objective of the study was to study various clinical patterns of facial pigmentation, their clinical characteristics, their association with other pigmentary disorders and to evaluate the different etiotogical and precipitating factors. A special proforma was prepared. Patients were thoroughly interviewed and examined to find out dermatological and systemic diseases and they were subjected to investigations to evaluate different etiological factors and diagnose the clinical type of facial pigmentation.<strong></strong></p><p class="abstract"><strong>Results:</strong> The present study showed a strong female preponderance. Among the total study population there were 55% cases of melasma, 20% cases of Riehls melanosis, 10% cases of periorbital pigmentation and 5% of miscellaneous causes.</p><p><strong>Conclusions:</strong> Facial pigmentation was commonly seen in the females. 21-30 years age group was the most commonly affected age group in all types of facial pigmentation. Melasma, Riehls melanosis and periorbital pigmentation were the most common clinical types of facial pigmentation observed.</p>

A clinico-dermatoscopic study of 100 cases of melasma in a tertiary care hospital

<p class="abstract"><strong>Background:</strong> Melasma is one of the most common hyperpigmentary disorders seen among Indian patients. Dermatoscope is a non-invasive tool that helps in visualization of surface and sub-surface changes. Recognition of characteristic dermatoscopic patterns of melasma helps in differentiating it from other hyperpigmentary disorders. The present study was carried out to study clinical and dermatoscopic patterns of melasma.</p><p class="abstract"><strong>Methods:</strong> A total of 100 patients with clinical diagnosis of melasma were enrolled in this study. These patients were first examined clinically and then under dermatoscope. All the findings were recorded.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of total 100 patients, 91 were females and 9 were males. Mean age of presentation was 34.86 years. Malar distribution pattern was the most common pattern observed in 54% patients. On dermatoscopic examination, 58% cases had epidermal melasma, 23% had dermal melasma and 19% had mixed melasma. Accentuated pseudoreticular network was the most common pattern seen in 88% cases.</p><p><strong>Conclusions:</strong> Melasma is a distressing hyperpigmentary disorder. Dermatoscope helps in diagnosis and prognosis of melasma. Therapeutic efficacy of various modalities can be monitored using dermatoscope. It has reduced the need of invasive interventions like biopsy from face for histopathology. </p>

The Role of Triple Combination Topical Agents in the Treatment of Facial Melasma

Melasma is an acquired, symmetrical hypermelanosis of the face and is particularly seen in women with skin types IV to VI living in areas with intense UVR. So it is a great problem in our country. Treatment of melasma remains a challenge. Topical therapy with a triple combination topical agents appears to be the most clinically effective initial therapy for patients with melasma. A clinical trial was conducted to find out the efficacy of the triple combination of 4% hydroquinone, 0.05% tretinoin and 0.01% fluocinolone acetonide cream in the treatment of facial melasma. Fifty clinically diagnosed cases of melasma attending the Skin and VD outpatient department of General Hospital, Faridpur were selected randomly. Majority (54%) were between 21 to 25 years of age and most of them (86%) were female. After 20 weeks of treatment with triple combination agents, the average MASI score decreased significantly (P<.001). Reduction of the severity of melasma by 20 weeks is 82% and by 8 weeks is 71%. Regarding the distribution of melasma, 50% were found centrofacial, 45% malar and 5% mandibular. As side effects of the treatment, 36% developed erythema, 16% developed burning sensation, 6% developed pruritus and 4% developed desquamation. This study demonstrates that every night application of triple combination topical agent has significant effect on melasma.Faridpur Med. Coll. J. Jul 2017;12(2): 68-70

The Role of Combination of 20% Azelaic Acid with 0.05% Tretinoin Cream in the Treatment of Melasma - A study in FMCH.

Melasma is characterized by melanosis with sharply demarcated blotchy, brown macules usually in a symmetric distribution over the cheeks and forehead and sometimes on the upper lip and neck. It is most often seen in women during pregnancy, at menopause and while taking oral contraceptives; it occasionally occurs in women who are not pregnant or taking oral contraceptives, as well as men. So it is a great problem in our country. A clinical trial was conducted to find out the effect of the combination of 20% azelaic acid with 0.05% tretinoin cream in the treatment of melasma. Twenty clinically diagnosed cases of melasma attending the outpatient department of Dermatology and Venereology, Faridpur Medical College Hospital, Faridpur were enrolled. Majority of the study subjects (40%) were between 26 to 30 years of age and most of them (60%) were females. Regarding occupation, 60% were housewife. Out of the study subjects 75% were married and 60% were middle class. Around 60% cases had positive family history of melasma and maximum (90%) patient had no history of systemic drug and the maximum (80%) patients had no history of use of cosmetics. It was observed that highest (90%) number of patients had malar area involvement and 10% had centro-facial area involvement. The study showed moderate reduction of the severity of melasma after the treatment. Out of the study subjects, 40% and 20% developed burning sensation and erythema respectively. It could be concluded that combination of 20% azelaic acid and 0.05% tretinoin cream, has a moderate lightening effect in the treatment of melasma.Faridpur Med. Coll. J. Jul 2016;11(2): 50-53

Identification of Genotypes and Allelic Frequencies of Vitamin D Receptor Gene Polymorphism (TaqI) in Egyptian Melasma Patients.

Background:Melasma is a characteristic pattern of facial hyperpigmentation, occurring primarily on the forehead, cheeks, and chin, in a mask-like distribution. The pathogenesis of melasma is not fully understood. Vitamin D plays a role in skin pigmentation. It exerts its effect through vitamin D receptor (VDR), which is expressed in variable cells including normal melanocytes.Aim and Objective:The aim of the current work was to investigate if VDR gene polymorphism (TaqI) confers susceptibility to melasma in Egyptian patients.Materials and Methods:A total of 45 female patients with melasma were recruited and 50 healthy subjects that were matched on age, sex, body mass index, and skin phototype, were included as a control group. TaqI polymorphism was investigated using restriction fragment length polymorphism polymerase chain reaction (RFLP PCR).Results:Presence of (t) allele and (tt) genotype was significantly associated with melasma cases compared with control group (P < 0.001 for both). No significant association was found between (tt) genotype or (t) allele and clinical data of the studied cases.Conclusion:TaqI polymorphism is associated with melasma. Further, large-scale studies are recommended to underscore and validate the current findings. It is also necessary for future studies to extend the research to other populations and ethnicities. Investigating other VDR gene polymorphisms in melasma is also warranted. Since melasma is a multifactorial disease, gene–gene and gene–environment interactions should be considered in future genetic-epidemiologic researches to apply more comprehensive insight into the role of VDR gene in its pathogenesis.

Fractional resurfacing in the Asian patient: Current state of the art.

Fractionated photothermolysis (FP) has revolutionized modern laser technology. By creating selective columns of microthermal damage, fractionated devices allows for greater treatment depths to be achieved without the prolonged downtime and risk of complications seen in traditional fully ablative laser resurfacing. Fractional resurfacing is a proven method to treat a variety of cutaneous conditions. In the Caucasian patient, a wide range of devices and treatment settings can be utilized safely and effectively. However, ethnic skin requires special consideration due to its unique pigmentary characteristics and clinical presentations. In this review article, we detail the current indications and strategies to optimize results and mitigate complications when utilizing fractional resurfacing for the Asian patient. A review of the MEDLINE English literature was conducted on fractionated laser devices studied in the Asian population. Articles included describe non-ablative devices including fractionated erbium glass, thulium fiber, diode, and radiofrequency devices; and ablative devices including fractionated carbon dioxide (CO2 ) laser, erbium yttrium aluminum garnet and yttrium scandium gallium garnet (YSGG) laser. These data were integrated with the expert opinion of the authors. Taking into account the unique characteristics and cosmetic concerns of the Asian population, fractional resurfacing can be considered a safe and effective option for the treatment of atrophic and hypertrophic scarring, and photorejuvenation in ethnic skin types. Select cases of melasma may be treated with fractionated non-ablative devices, but utilized with caution. The predominant complication associated with fractional resurfacing for these conditions is post-inflammatory hyperpigmentation (PIH) and rebound worsening of melasma. A greater number of treatments at lower density settings and wider treatment intervals typically produce the lowest risks of PIH without compromising treatment efficacy. Lasers Surg. Med. 49:45-59, 2017. © 2016 Wiley Periodicals, Inc.

Melasma and Endocrine Disorders

Melasma is an acquired and chronic disorder characterized by a localized symmetrical hypermelanosis of the face or, less frequently, involving the neck and forearms. It occurs with a high prevalence during pregnancy, especially during the second half of the gestational period, and in women taking exogenous female hormones. Melasma has also rarely been described in males, especially those affected by primary hypogonadism or taking estrogens for prostatic cancer. Melasma thus appears to be pathologically related to female sex hormones, but this is not consistently reflected in high circulating levels of estrogens or progesterone. This implies that other factors are likely to be relevant, including genetic predisposition, exposure to ultraviolet light, cosmetics and some medications. Melanocortins play a key role in melanogenesis but no cases of melasma have been described in pituitary or adrenal diseases, including those associated with an increase in serum ACTH. An association between melasma and thyroid disorders has been reported only once and not confirmed in subsequent studies. The skin is both a source of, and a target for vitamin D; however, no cases of melasma have been described in association with disordered vitamin D production. Finally, clinicians should distinguish the localized hypermelanosis of melasma from general hyperpigmentation occurring in pregnancy or in pituitary and adrenal diseases associated with a raised serum ACTH.

Clinico-epidemiological Study and Quality of Life Assessment in Melasma.

Background:Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. The precise cause of melasma remains unknown. It is notably difficult to treat and has a tendency to relapse. Its population prevalence varies according to ethnic composition, skin phototype, and intensity of sun exposure. Due to its frequent facial involvement, the disease has an impact on the quality of life of patients.Aims:To study the clinico-epidemiological pattern, dermascopy, wood's lamp findings and the quality of life in patients with melasma.Settings and Design:Observational/descriptive study.Materials and Methods:Patients with melasma were screened. History, clinical examination, Wood's lamp examination (WLE) and dermoscopy were done. Severity of melasma was assessed by the calculating melasma area severity index (MASI) score. Quality of Life (QOL) was assessed using MELASQOL scale with a standard structured questionnaire.Statistical Analysis:Descriptive, Chi-square test and contingency coefficient analysis.Results:In 140 cases of melasma, 95 (67.9%) were females and 45 (32%) were males. Common age group affected was 31-40 years (65%). Majority were unskilled workers with average sun exposure of more than 4 hours (44%). Family history was observed in 18% cases. Malar type (68%) was the most common pattern observed. Mean MASI score was 5.7. WLE showed dermal type in 69% cases. Common findings on dermoscopy were reticular pigment network with perifollicular sparing and color varying from light to dark brown. Mean MELASQOL score was 28.28, with most patients reporting embarrassment and frustration.Conclusions:This study showed that melasma has a significant negative effect on QOL because though asymptomatic it is disfiguring affecting self-esteem. Dermoscopic examination did not help in differentiating the type of melasma.

Hormonal profile of melasma in Indian females

Background: Several factors have been implicated in the etiology of melasma which include ultraviolet radiation, genetics, pregnancy, skin type, and drugs. However, there is a paucity of literature regarding the role of endocrine factors. Aim: To study the clinical and hormonal correlation in female patients with melasma. Methods: A total of 30 untreated female patients with melasma were included in the study. The control group included an equal number of age-matched females. Assays of free testosterone, total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone (LH), follicle stimulating hormone, prolactin, 17β-estradiol (E2), progesterone, free triiodothyronine, free tetraiodothyronine, thyroid stimulating hormone were done on the 5th or 6th day of the menstrual cycle in the midfollicular phase. Results: The difference between means of free testosterone, total testosterone, LH, estradiol, progesterone, and free thyroxine of melasma cases and controls was found to be statistically significant. No correlation was found between the severity of melasma and the mean hormone levels. Conclusion: It can be inferred that these hormonal alterations may represent a subclinical evidence of a suppressed hypothalamic-gonadal axis and preclude the role of hormones in the pathogenesis of melasma.

The Role of Combination of 20% Azelaic Acid with 0.05% Tretinoin Cream in the Treatment of Melasma

Melasma is characterized by brown patches, typically on malar prominences and forehead. The pigmented patches are usually affect darker complexioned individual especially Asian. So it is a great problem in our country. A clinical trial was conducted to find out the effect of the combination of 20% azelaic acid cream with 0.05% tretinoin cream in the treatment of melasma. Thirty clinically diagnosed cases of melasma attending the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, were enrolled Majority of !he study subjects (43%) were between 26 to 30 years and most of them (73.3%) were female. Regarding occupation 56.7% were housewife. Out of the study subjects 70% were married and 86.7% were of middle class. Around 66.7% cases had positive family history of melasma and maximum 93.3% patient had no history of systemic drug and the maxim11m 73.3% patient had no history of use of cosmetics. It was observed that highest (93.3%) number of patients had malar area involvement and 6. 7% had centro-facial area involvement. The st11dy showed that after treatment, the average MASI (Melasma Area and Severity Index) score was decreased by 38 66% indicating moderate reduction of the severity of melasma Out of the study subjects, 50%, 30%, 16% developed burning sensation, itching and erythema respectively It could be concluded that combination of 20% azelaic acid and 0.05% tretinoin cream, has a moderate lightening effect in the treatment of melasma. DOI: http://dx.doi.org/10.3329/bmj.v40i2.18501 Bangladesh Medical Journal 2011 Vol.40(2): 26-30

Meian granule in treatment of melasma: a clinical trial

Objective To evaluate the efficacy and safety of Meian granule in the treatment of patients with melasma and to investigate the recurrence rate.Methods The patients,who were diag nosed pathologically as melasma from November 2010 to April 2011 in our department and accorded with the standards that we supposed,were enrolled in this study.They were then divided into three groups:Meian granule group (group A),Meian granule group (group B) and control group (group C).Patients in group A were given a packet of Meian granule each time,once a day,and those in group B were given a packet of Meian granule each time,twice a day for 2 months.Patients in group C were treated by Antixin (3 pills,thrice a day).The efficacy and safety were observed and analyzed by using statistical methods after the treatment.All the cases were followed up for a month at out-patient department or by telephone.Results A total of 158 cases of melasma were treated,including 54 cases in group A,51 cases in group B,and 53 cases in group C. The effective rates were 58 ％,52 ％,and 60 ％ in groups A,B and C,respectively.There was no significantly statistical difference (P＞0.05) of effective rates amoung the three groups.One month after the treatment the recurrence rates were 3.3 ％,15.3 ％,and 10.0 ％ in the groups A,B and C,respectively.The incidence of adverse reactions during the study were 14.8 ％,15.6 ％,and 7.5 ％,respectively.Conclusions It has been proved that Meian granule is an effective and reliable treatment for melasma. Key words: Melasma; Meian granule; Therapeutic effects

Histological classification of melasma with reflectance confocal microscopy: a pilot study in Chinese patients

To investigate the histological classification of melasma with reflectance confocal microscopy (RCM) in vivo. Two hundred and ten cases with facial melasma lesions were enrolled. After informed consent, the target melasma lesion of 10 patients were imaged with RCM and then biopsied as well. Under the RCM scanning, the distribution of the melanin determined the histological types, and then, the results of RCM images were compared with those of the histopathology. The other 200 cases were tested only with RCM. For the 10 cases imaged and biopsied, compared with that of the perilesional normal skin, the amount of melanin was significantly increased in the epidermis in all lesions under RCM, while three cases also found melanin in the dermis. Thus, seven of the 10 patients were categorized as the epidermal type while the other three as mixed ones, and the results were well correlated with those of the histopathology. Of the other 200 patients, 143 cases 71.5%) were categorized as the epidermal type while the other 57 (28.5%) cases as mixed ones. If more melasma cases are biopsied, the data will be more convincing. RCM in vivo analysis shows complete coherence with histopathology results, which could be an alternative for the classification of melasma, and based on the results of RCM imaging, melasma is classified into two major types: the epidermal type and mixed type.

Elimination of melasma with nonablative Q-switched Nd :YAG 1 064 nm laser

Objective To evaluate the elimination of melasma with nonablative Q-switched Nd : YAG1 064 nm laser. Methods 23 cases of melasma were treated with Q-switched Nd :YAG 1 064 nm laser using the following parameters: spot size, 6 mm; pulse duration, 5-7 ns; frequency, 10 Hz, and flu-ence, 1.8-2. 0 J/cm2. The procedure was repeated weekly. Results The treatment was well tolerated without the use of topical anesthetic. There was slight congestion, no blister and crust after treatment. Routine clean and make-up can be done after treatment. The melasmas were obviously lighten or fully eliminated after 8-10 treatments and 52. 17 % of patients showed excellent results. Only 5 cases experienced an episode of purpura on eyelid after treatment and disappeared spontaneously without post-inflammatory hyperpigmentation and scarring. Followed up over 6 months, there was recurrence in 7 patients who were effective by additional treatment. Conclusions Nonablative Q-switched Nd :YAG 1 064 nm laser is a more ideal method to eliminate melasma because of the credible effect, safe, simple operation, and no downtime, in despite of recurrence. Key words: Nonablatives Q-switched Nd : YAG 1 064 nm laser; Melasma

Treatment of refractory melasma with the MedLite C6 Q-switched Nd:YAG laser and alpha arbutin: A prospective study

Objective: To evaluate the effectiveness of a Q-switched Nd:YAG laser (MedLite C6; HOYA ConBio, Fremont, CA, USA) and 7% alpha arbutin solution (Skin Advance Laboratory, Japan) in the treatment of melasma. Methods: This was a prospective study of 35 refractory melasma cases treated with 10 weekly laser sessions, two monthly follow-up treatments and topical 7% alpha arbutin solution. Clinical photographs and severity grading on a 5-point scale were carried out by an independent observer at each visit. Results: At 6 months, 30% of study subjects received results in the excellent clearance category (> 81% reduction of melasma) and 36.7% received good (51–80% reduction) clearance. Mild and transient side effects included discomfort during treatment, erythema, whitening of fine hair and urticaria. Three cases of mottling hypo-pigmentation (8.57%) and two cases of recurrence of melasma (5.71%) were recorded. Conclusion: Combination therapy with the MedLite C6 and 7% alpha arbutin solution is an effective and well-tolerated treatment for refractory melasma.

A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma

It has been generally believed that the four main causes of melasma are pregnancy, hormonal contraception, family history and sun exposure; however, there are few published comprehensive studies that confirm these assertions. The Pigmentary Disorders Academy - an international group of experts in pigmentary disorders - designed and conducted a global survey of women to investigate the effect of these factors on onset and chronicity of melasma and the course of the disease in order to gain a better understanding of the causative factors associated with this disorder, with a particular focus on hormonal factors and UV exposure in females. A 40-item largely self-administered questionnaire was completed by 324 women being treated for melasma in nine clinics worldwide. The mean age at onset of melasma was 34 years, and 48% of subjects questioned had a family history of melasma (97% in a first-degree relative). Subjects with family history of melasma tended to have darker skin (90% types III-VI) compared to those without (77% types III-VI). The most common time of onset was after pregnancy (42%), often years after the last pregnancy, with 29% appearing pre-pregnancy and 26% during pregnancy. Onset was related to darker skin type post-pregnancy (P = 0.002). Risk of onset during pregnancy was associated with having spent more time outdoors (an extra 10 h per week spent working outside increases the odds of onset of melasma during pregnancy by approximately 27%) and an increased maternal age at pregnancy (increased by approximately 8% for each year of age at first pregnancy; P = 0.02). The odds of melasma occurring for the first time during a pregnancy were also increased with multiple pregnancies (twice the odds if 2 vs. 1 pregnancies, three times higher if 3 or more vs. 1 pregnancy). Of the women, 25% who had used hormonal contraception claimed that melasma appeared for the first time after its use, the rate being higher for those without vs. with a family history. The results suggest that, whilst accepted causes do affect onset of melasma, a combination of these factors often triggers this disorder. These factors may provide further insights into how physicians can manage individual melasma cases, support recommendation of preventative measures and even anticipate treatment results and recurrence.

Chlamydia trachomatis infection and photosensitive dermatoses

Background: Photosensitivity to Chlamydia trachomatis has been described in almost 50% of chronic cases of lymphogranuloma venereum (LGV) caused by L1, L2 or L3 serovars. Photosensitivity in non LGV strains of C trachomatis has not been studied. We studied the association of various photosensitive dermatoses with C trachomatis infection in non LGV cases. Methods: Sera of all the cases of photosensitivity, melasma, chronic actinic dermatitis (CAD), polymorphic light eruption (PLE), actinic prurigo (AP) and rosacea were tested for the presence of IgM, IgG and IgA antibodies to C trachomatis by ELISA method. The results were compared with 30 healthy controls. Result: Seventeen (25.53%) of 57 cases of photosensitivity as against two (6.67%) controls were seropositive for IgM/IgG/IgA antibodies, a statistically significant difference (χ 2 6.18, p 0.013). Similarly, significantly higher seropositivity was observed in 12 (25.53%) of 47 cases of melasma (χ 2 4.38, p 0.0363) and six (46.15%) of 13 cases with CAD (χ 2 6.91, p 0.0086). Although higher proportion of patients of rosacea [five (31.25%) of 16 cases] and PLE [four (25.0%) of 16 cases] were seropositive, the difference was not statistically significant (χ 2 3.23, p >0.05, OR 6.36, CI 95% 0 to 48 and χ 2 3.09, p 0.078, OR 4.67, CI 95% 5 to 41 respectively). There was no association of AP. Conclusion: The observations suggest that C trachomatis infection in non LGV cases is an important cause of PS, melasma and CAD. It appears to be an important cause of rosacea and PLE. We recommend that all cases of photosensitivity, melasma, CAD, PMLE and rosacea and their spouses/sexual contacts be investigated for C trachomatis infection.