Etiology Of Melasma Research Articles

The Correlation between Melasma and ABO Blood Type

Aim: Melasma is an irregular brown hyperpigmentation mostly observed in the middle face. Although genetic predisposition, ultraviolet radiation and female sex hormones have been reported as the main causes, inflammatory processes were also considered to play a role in melasma. It has been determined that blood groups play a role in many genetic and inflammatory diseases. Since the genes that encode blood types were associated with inflammation, blood type could play a role in the etiology of melasma, an inflammatory and genetically inherited disease. The present study aimed to investigate the correlation between melasma and ABO/Rh blood types, which has never been investigated before.
 Material and Methods: The study was conducted 100 patients with melasma and 1000 healthy controls. The patient and healthy control blood types and Rh factor data were collected from the hospital automation system retrospectively.
 Results: Female gender ratio was significantly higher in the patient group compared to the control group (p

The Profile and Triggering Factors of Melasma Patients: A Retrospective Study

Background: Melasma is a skin pigmentation disorder characterized by brownish hyperpigmented lesions with symmetrical distribution and irregular borders. It becomes a cosmetic problem that causes a negative impact on quality of life and a lack of confidence in patients. The etiology of melasma is not completely understood, but several factors that trigger melasma can be explained. Yet, the profile and triggering factors associated with the prevalence of melasma patients in Surabaya are still unexplored. Purpose: To determine the profile and triggering factors of melasma patients in the Dermatology and Venereology Outpatient Unit of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Methods: A retrospective descriptive study using data from medical records with a total sampling technique. Result: In this study, most of the melasma patients were female (97.5%), dominated by the age group 46-55 years (49.4%), and worked as housewives (40.74%). The triggering factors found in patients were sun exposure (96.3%), cosmetics (67.9%), hormonal (49.4%), and family history (22.2%). The physical examinations of melasma lesions showed that they were mostly located in the malar area (72.8%), light brown colored (74.7%), and 2.0 – 4.0 cm in size (54.3%). Wood’s lamp examination showed that most of the lesions had firm and indistinct borders (55.6%). Conclusion: The triggering factors of melasma are multifactorial, but we suspect that sun exposure plays an important role in affecting melasma.

The history of melasma: Its roots and evolution

AbstractMelanosis or “black degeneration” was the first term used to describe a diseased state involving darkening of visceral structures. In 1910, melanosis localized to the skin was described and years subsequent to that the term chloasma was coined to describe dark facial pigmentation. Melasma and chloasma were used interchangeably for many years until melasma became the more widely used term to describe dark facial pigmentation in a butterfly distribution. For decades, there have been various theories regarding the etiology of melasma. In the 1930s, it was theorized to have been caused by perfume application to the upper cutaneous lip and was associated with vitamin C deficiency. It was thought to only occur in women until cases arose of in men around 1988. It was also thought to occur exclusively in white skin until studies in the early 1960s found the incidence of chloasma to be as high as 34% among Puerto Rican women taking contraceptives. It was not until 1963 that a study found an association between melasma and oral contraceptive use, tying the cause of the pigmentation to underlying hormonal exposure. To date, there has been a significant increase in the understanding of the pathogenesis of melasma as well as treatment options to keep it in remission, though no cure exists at this time. The purpose of this study is to provide a historical overview of the evolution of melasma as a clinical condition as well as an understanding of its pathogenesis and treatment options.

Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Melasma is characterized by symmetrical brownish macules with well-defined borders. The etiology of melasma is still unknown, but factors that are thought to influence include genetic predisposition, ultraviolet radiation, hormonal factors, thyroid disorders, use of cosmetics, and drugs. This study aimed to determine the epidemiological data, evaluate risk factors, management, and follow-up in new melasma patients. Methods: The medical records of patients with melasma attending Dermatology and Venereology Outpatient Clinic over a 4-year period from 2015 to 2018 were analyzed retrospectively for this descriptive, observational study. Data were analyzed using SPSS version 23 for Windows. Results: This study found 739 new melasma patients from January 2015 to December 2018, with the proportion of women 734 patients (99.3%) more than men only 5 patients (0,7%). The age of most patients who were treated was 46-55 years in 320 patients (43.3%), with the highest age of onset being 37-45 years in 308 patients (41.7%). About 561 patients (75.9%) had a melasma duration of more than 1 year. The most common job of melasma patients was housewives in 366 patients (49.5%). The most frequent risk factor for melasma was ultraviolet radiation in 258 patients (34.9%). The most common melasma was malar type in 482 patients (65.2%) and mixed melasma in 617 patients (83.4%). The most widely administered therapy was sunscreen in 735 patients (99.5%) and Tretinoin 0.05% in 235 patients (31.8%). Most patients did not make repeat visits as many as 448 patients (60.6%). Conclusion: The most common disease in women of childbearing age with ultraviolet radiation is the most precipitating risk factor. The low number of patient repeat visits can be caused by a lack of doctor education or a lack of patient adherence to treatment due to chronic and recurrent diseases.

The Relationship between Triiodothyronine and Thyroid Stimulating Hormone Serum Level into Melasma Severity

Background: Melasma is a chronic acquired hypermelanosis of the skin and relatively common skin disorder that primarily affects sunlight-exposed areas in women. While etiology of melasma is not yet well understood, a possible factor is thyroid hormones. Few studies have been conducted in order to find the relationship between melasma and thyroid disorders with varying results. This study is conducted to investigate the association between thyroid parameters (triiodothyronine and thyroid stimulating hormone) and melasma severity. Aim:To determine the relationship between triiodothyronine (T3) and thyroid stimulating hormone (TSH) serum level into severeity of melasma. Subject and method: Thirty six women with melasma aged >18 years old are included in the study group indoor at Dr. M. Djamil Hospital Padang. Exclusion criteria: pregnancy/lactation, using oral contraception, using hormonal therapy, taking photosensitizer systemic antifungi and anticonvulsant and taking topical/systemic of melasma treatment. History of sun protection usages and MASI score are recorded. Triiodothyronine and TSH level are measured by electrochemiluminescence-immunoasay (ECLIA) method. Result: Mean age of melasma patients in this study: 47.52±8.11 years old. Malar type is more common than centrofacial (61,1%) and we did not find mandibular type. The most common severity of melasma: mild (19 out of 36 people). MASI score: 21.46±10.40. Mean serum level of T3 and TSH: 1.578±0.282nmol/L and 1.773±1.457 μIU/L (p>0,05). Conclusion: Mean serum levels of T3 and TSH hormones are not related to the severeity of melasma. Nevertheless, increasing levels of hormones are in accordance with the increase of melasma’s severeity degree, although it is not statistically significant. Further study could be done by adding hypothyroidism to patients who have melasma and comparing them with control group by using cross-sectional comparative sampling. An equal sample number of each severity degree of melasma would be ideal and then evaluate psychological/stress factors to the subjects

Melasma treatment: A novel approach using a topical agent that contains an anti-estrogen and a vascular endothelial growth factor inhibitor

Melasma is an acquired disorder of pigmentation that presents with asymptomatic symmetric darkening of the face. The pathogenesis of this condition is multifactorial and influenced by several factors including female sex hormones, genetic predisposition and ultraviolet light exposure. The management of melasma is usually directed at more than one of the causative etiologic factors and often incorporates a combination of topical agents, with or without the addition of physical modalities. Estrogen and angiogenesis are significant factors in the etiology of melasma. A useful addition to the therapeutic armentarium for treating melasma would include a topical agent that could effect both of these causative factors. Specifically, a topical preparation consisting of an anti-estrogen and a vascular endothelial growth factor inhibitor would accomplish this goal. Suitable candidates that target estrogen receptors and vascular endothelial growth factor are currently used in medical oncology as systemic antineoplastic agents. The anti-estrogen could be either a selective estrogen receptor modulator (such as tamoxifen or raloxifene) or an aromatase inhibitor (such as anastrozole or letrozole or exemestane). The vascular endothelial growth factor inhibitor would be bevacizumab. In conclusion, a novel–topically administered–therapy for melasma would combine an anti-estrogen and a vascular endothelial growth factor inhibitor.

The Relationship Between Herbal Anticoagulants and Melasma

Context: Melasma is a common pigmentary disorder with the incidence of 1.5% - 33.3% worldwide. Targeting the vascular component in melasma lesions may decrease the melanocytic stimulation. Herbal anticoagulants can serve as effective candidates for melasma treatment. Evidence Acquisition: The evidence was gathered in this study by evaluating vascularization as an etiology of melasma and considering the role of herbal anticoagulants in natural vascular treatment. Databases such as PubMed and Scopus were screened and the following keywords were searched: melasma, vascularization, pigmentation, and herbal anticoagulant. These subjects were further investigated in traditional textbooks such as the canon of medicine by Avicenna and Alhavi by Razi. At the end, the results were discussed. Result: The use of anticoagulants can reduce the clot formation and lower the VEGF release. In this way, vascularization will be reduced, consequently leading to a decrease in melasma occurrence. The researchers of the present study went over the herbal components that were effective for treatment of melasma and found that most of them consisted of anticoagulants such as coumarin. Conclusion: The effect of herbal anticoagulants (administered orally) on melasma should be evaluated clinically and their combination with topical treatments is suggested.

Extrafacial melasma over forearms.

Sir, Melasma is a common hypermelanoses affecting the female gender. The etiology of melasma has not been clearly identified. Factors associated with melasma include exposure to ultraviolet light, pregnancy, oral contraceptives, hormone replacement therapy, thyroid autoimmunity, cosmetic ingredients, and phototoxic drugs.[1] The commonest site affected by melasma is the face and has been distinguished into three clinical patterns, namely, centrofacial, malar, and mandibular. Extrafacial melasma is a rare entity and has been very rarely reported in the literature. Extrafacial melasma should be distinguished from acquired brachial cutaneous dyschromatosis (ABCD).[2] A 55-year-old woman presented with brownish pigmentation of her both forearms for past six years. She reported that initially few brown hyperpigmented asymptomatic spots appeared on her right forearm and similar pigmented spots started appearing on the other forearm too. She denied any history of inflammatory dermatoses prior to appearance of her skin problem. The patient was postmenopausal since three years. She reported that the pigmentation became more prominent on sun exposure. She denied the intake of oral contraceptive pills or hormone replacement therapy. There was no history suggestive of thyroid dysfunction. She did not give history of receiving any photosensitizing drugs. Cutaneous examination showed a large, brown irregular patch on her right forearm and a similar developing lesion on her other forearm. The patches comprised of multiple coalescing hyperpigmented macules with irregular borders with intervening areas showing normal skin. She also had malar type of facial melasma [Figure 1]. We made a provisional diagnosis of extrafacial melasma and ABCD. Potassium hydroxide mount from the patches failed to show any fungal elements, which ruled out pityriasis versicolor. Wood's lamp examination showed accentuation of pigmentation suggestive of epidermal pigmentation. Skin biopsy from the lesion showed epidermal thinning and increased melanization of basal layer [Figure 2]. Histology showed minimal epidermal atrophy and mild solar elastosis in the form of elastic fiber degeneration. No evidence of amyloid material was seen on special stains, which ruled out frictional amyloid deposition. On a review of the literature, we were able to rule out acquired brachial cutaneous dyschromatosis as there were no hypopigmented atrophic macules. On correlation, we made a diagnosis of extrafacial melasma involving dorsa of both forearms.Figure 1: Patient having malar type of melasma and brownish pigmentation on dorsa of both forearmsFigure 2: H and E stained section of biopsy showing epidermal thinning and increased melanization of basal layers (×20)Extrafacial melasma is an uncommon variant of melasma and has been very rarely reported in the literature. Extrafacial melasma shares similar clinical features as that of facial melasma with brownish hyperpigmented spots with irregular borders. Although facial and extrafacial melasma share some clinical features, they differ in incidence. Melasma occurs predominantly in the age group of 20–40 years with a mean age of 33 years and is rarely observed in menopausal females.[3] Extrafacial melasma is known to affect menopausal women in the fifth decade of life.[4] A close differential for extrafacial melasma affecting forearm is ABCD. ABCD is characterized by dyschromatosis (hyperpigmented and hypopigmented macules) and face is never involved, whereas extrafacial melasma lacks hypopigmented atrophic macules. ABCD has a strong causal association with antihypertensive drugs particularly angiotensin converting enzyme inhibitors.[2] A striking observation in cases of ABCD is poikiloderma of the neck (Civatte), which may be incidental in cases of extrafacial melasma. Histologically, extrafacial melasma resembles facial melasma with increased pigmentation of basal layer and epidermal atrophy. Both the entities show signs of chronic actinic damage on histology Skin biopsy in our patient showed epidermal thinning, which can be a sign of chronic actinic damage. Treatment of extrafacial melasma can be challenging with frequent relapses. Depigmenting drugs, retinoids, and sunscreen are the mainstay of therapy for extrafacial melasma.[56] It is premature to comment whether extrafacial melasma responds to depigmenting therapy akin to typical facial melasma. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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.

Advances in the medication treatment of melasma

Melasma is a common acquired pigmentation disorder in clinic.The etiology of melasma remains unknown,and there is still no satisfying therapy.Medication treatment is the primary therapy for melasma at present,which mainly inhibits melanogenesis via suppressing tyrosinase synthesis,preventing melanosome transport to keratinocytes,and accelerating epidermal turnover.Tyrosinase inhibitors are the most widely used medication,whereas there is still no enough evidence for the application of plant extracts in the treatment of melasma.Treatment principles of melasma mainly include utilization of definitely effective therapy as well as safe and appropriate maintenance regimens.Further insights into the pathogenesis of melasma and the advent of genetic engineering therapy may provide new ideas for the treatment of melasma. Key words: Chloasma; Drug therapy, combination