Melasma is commonly known as “butterfly spot”, “liver spot” or “stretch mark”. It mainly occurs on the face, mainly on the cheek, cheek, nose, forehead and chin. It is a brown or black patch with unclear border, mostly symmetrical.
I. Etiology
The appearance of chloasma is mostly related to endocrine, especially the estrogen level of women, menstrual disorders, pregnancy, taking contraceptive pills or poor liver function and chronic kidney disease may appear chloasma. In addition, sunlight and mental factors can also aggravate chloasma in pregnant women, which often appears after the third month of pregnancy and fades gradually when menstruation returns to normal after delivery. If it does not subside for a long time, treatment is needed.
Differential diagnosis
Melasma needs to be differentiated from freckles, post-inflammatory hyperpigmentation, zygomatic brownish nevus, melanosis, pigmented lichen planus, etc.
Classification of melasma
The most commonly used classification is according to the depth of classification, generally divided into 4 categories.
1.Epidermal type
Melanin is mainly located in the epidermis and is light brown in color. When irradiated with filtered ultraviolet lamp (i.e. long-wave ultraviolet lamp, also known as Wu lamp), the epidermal black color deepens.
2.Dermal type
The melanin is mainly in the superficial layer of the dermis, which is blue-gray. After irradiation with Wu lamp, the pigment does not deepen.
3.Mixed type
The melanin is in the epidermis and the superficial layer of the dermis, which is clinically dark brown. Both are present after irradiation with Wu lamp.
4.Uncertain type
A small number of patients with brown or black spots cannot be classified more accurately under Wood’s lamp.
IV. Principles of local treatment of melasma
The general principle of local treatment is to inhibit melanin formation, which can be used as follows
1, tyrosinase inhibitors.
2.drugs that hinder melanin biosynthesis.
3, melanocyte toxicity drugs.
4, drugs that interfere with melanocyte metabolism.
5, drugs that promote melanin reduction.
6.Drugs that hinder the adhesion of epidermal keratinocytes, soften keratinocytes and enhance their flexibility.
V. Chinese medicine treatment of melasma
The principles of Chinese medicine treatment for melasma are: the treatment for spleen deficiency and liver depression is based on the principles of strengthening the spleen, soothing the liver, regulating qi and activating blood. The treatment for liver and kidney yin deficiency type is based on nourishing liver and kidney, nourishing blood and activating blood. The treatment for the type of Qi and Qi stagnation is to harmonize the Qi and Qi, regulate Qi and invigorate Blood.
1.Liver depression and qi stagnation type of chloasma
This type of spots is mainly caused by liver disorder, mainly manifested as emotional loss, depression and distress, liver fire and stagnant qi. The spots are brown or reddish-brown, often accompanied by distension and pain between the chest and the lower back, irregular menstruation and other symptoms, usually the spots deepen in color before menstruation, the patient has a white tongue and bitterness in the mouth. The treatment should be to smooth the Qi, activate the blood and remove blood stasis as the fundamental. It can be taken with the addition and subtraction of Chen Pi, Chai Hu, Radix Angelicae Sinensis, Atractylodes Macrocephala, Qing Pi, Salviae Miltiorrhizae, Safflower, Chokeberry, Poria and Radix et Rhizoma. If the patient’s menstrual bleeding is more obvious, decoction of Danshen and Yimoucao should be considered; if menstrual abdominal pain, consider taking Yanhuosuo and Wulin.
2.Spleen deficiency chloasma
It is mainly caused by overexertion and diet disorder, which leads to spleen and Yang deficiency, as well as qi and blood stagnation. Generally speaking, the spots are grayish brown or light black, mostly found on the cheek and forehead. The more obvious symptoms are: anorexia, body weakness, light color of menstruation in the late menstrual period, lighter tongue color, thicker and greasier tongue coating, and light and weak pulse. Treatment should be considered from the perspective of strengthening the spleen, smooth the qi and resolve stasis while using general spot removal products. You can take Gui Spleen Soup with the addition and subtraction of Radix Codonopsis, Astragalus, Radix et Rhizoma, Poria, Huai Shan, Lentil, Huang Ling, Atractylodes, Zedoary, Safflower, Licorice, etc. In particular, patients with frequent abdominal distension should take more fried yam, houpo, rose hips, etc.
3.Chloasma of kidney yin deficiency type
The main reason for the formation of chloasma is overworking and straining the kidneys, or over-indulgence in sex and depletion of essence, resulting in loss of kidney yin and rising of deficiency fire, which damages the skin and forms brown spots. Generally, the spots are dark brown or dark brown, and the shape is very much like a butterfly, which is also called butterfly spot. When you have butterfly spot, you will often feel soreness and weakness of the waist and knees, dizziness, tinnitus and eye acuity, irritability and heat. In women who have dark red menstruation in the premenstrual period, the tongue becomes red at the same time, but the tongue coating becomes extremely inconspicuous, the treatment should be based on assisting to nourish yin and lower fire, eliminate blood stasis and remove spots. Six-flavored Dihuang Wan, plus or minus Huai Shan Yao, Fu Ling, Sheng Di Huang, Shu Di Huang, Xuan Shen, Tian Tian Tian Fan, Zhi Mu, Shan Yu Fei, Dan Pi, Dan Shen, Zhen Zhen Zi, Dry Lotus Grass, etc. can be taken. When the deficiency fire is too strong, we should add Zhi Mu and Huang Bai; those who are mentally weak, depressed and irritable can add Acanthopanax, Ling Xiao Hua and Mast.
4.Chloasma of kidney Yang deficiency
The main reason for the formation of chloasma is excessive sexual intercourse, mental deficiency, exhaustion of kidneys or long-term illness without attention to recuperation, resulting in Yang deficiency and weakness. The cold in the abdomen becomes strong, causing the Qi and blood to lose their gentleness, forming stagnation and damaging the face. The common color of such spots is gray-black, distributed like butterflies or maps on the cheekbones or cheeks. The obvious feeling is that the waist and knees become abnormally cold due to internal cold, the hands and feet are cold, the urine is clear but slow and long, the menstruation is late, the color is dark and easy to form lumps, the tongue is pale, the tongue coating is white, the pulse is heavy and sluggish, and the treatment must start with warming Yang and tonifying the kidneys. You can take Tao Hong Si Wu Tang and Pei Gui Di Huang Wan.
Disease Treatment
The treatment of melasma should be combined with internal and external treatment, first of all, the cause of the disease should be eliminated and strict sun protection should be applied. The most effective topical medicine is Kligman formula: 5% hydroquinone, 0.1% vitamin A acid and 0.1% dexamethasone. The most commonly used creams are Silk White Spot Cream and Hydroquinone Cream. There are some whitening cosmetics on the market containing arbutin, vitamin C/E and its derivatives, some plant flavonoids and polyphenol extracts, niacinamide and other whitening ingredients, which are also effective for external use and can be used in conjunction. Whether it is whitening cosmetics or drugs, the use time should be at least two months to see the effect, need to adhere to. In addition, fruit acid peeling. And vitamin C ion introduction and other treatments also have a relatively good treatment effect. There are also some Chinese medicines such as Jia Wei Yi Yao San and Tao Hong Si Wu Tang which may be helpful, but these medicines need to be taken for a long time and cannot be effective in the short term. All in all, melasma treatment is difficult and requires patience and slow adjustment.