Melasma is a hyperpigmented skin disease mostly found in the face of young and middle-aged women.
I. Etiology and pathogenesis
1.Ultraviolet radiation: In Hawaii where the sun shines directly all year round, almost all people have chloasma on their faces and arms. In layman’s terms, the body’s ability to resist ultraviolet rays is limited. If you over-expose yourself to the sun as a child, the ability to resist the sun will weaken day by day and will be exhausted at the age of 30 or so, showing a variety of photoaging pigmentation such as melasma, freckles and solar freckle-like nevus. In addition, many ladies or housewives who often sit in the office refuse to use sunscreen, then the ultraviolet rays in the fluorescent tubes, the ultraviolet rays through the window glass and the ultraviolet rays in the mosquito lamp will silently add up to the light damage and eventually form pigmentation.
2.Improper use of cosmetics: If hormones and other ingredients are added in cosmetics, once you stop using them, hormone rebound will be formed, leading to the aggravation of pigmentation which is difficult to control. We often see such patients who undergo spot removal treatment in beauty salons, and the effect is very obvious at the beginning, but after a few months, the skin becomes phenanthrene, sensitive and red bumps appear. Once you stop or change cosmetics you will have red spots, papules, even edema and exudation, which is typical of hormone dependent dermatitis. If functional cosmetics are used too early and too often, they can also cause skin thinning, sensitivity, and the formation of discoloration. For example, the redness of the skin of a 20-year-old woman after using a strong anti-wrinkle cream (containing a high concentration of retinoic acid) falls into this category. If the cosmetics used cause skin allergy or intolerance, the skin is always red, just like seborrheic dermatitis, and post-inflammatory hyperpigmentation is formed.
3. Pregnancy, also known as stretch marks, is related to the elevated level of estrogen (photosensitivity), which can disappear after delivery. Especially for ladies who insist on sunbathing during pregnancy without umbrella or sunscreen.
4. Neuro-endocrine disorders, such as postpartum and menopausal women. Some people are in a state of long-term mental tension, irritable, unable to control their emotions, and even insomnia and dreaminess. This state will easily lead to the aggravation of chloasma.
5.Drugs (such as birth control pills, chlorpromazine, phenytoin sodium, etc.).
6.Imbalance of trace elements, etc.
7.Chloasma can also occur in patients with certain chronic diseases (such as gynecological diseases, hepatitis, chronic alcoholism, hyperthyroidism, tuberculosis, visceral tumor, etc.).
8.Hereditary factors.
Clinical manifestations
It mostly affects young and middle-aged women, but it can also occur in men (such as men who love fishing, climbing and other outdoor sports). It is often aggravated in spring and summer and reduced in autumn and winter. It occurs symmetrically on the cheek and cheek in a butterfly shape, and can also involve the forehead, nose and mouth. Typical lesions are yellowish brown or dark brown patches, varying in size, with clear edges. There are no conscious symptoms. The duration of the disease is variable and can last for several months or years. Generally, after the age of 50, the discoloration will gradually recede towards the back of the ear and jaw, and finally only a little trace will remain on the neck. Therefore, we can hardly find melasma patients in the 70s and 80s.
III. Treatment
First of all, we should find the cause of the disease and deal with it accordingly; avoid sun exposure and make the habit of applying sunscreen; adjust emotions, avoid anxiety and keep a healthy mind; eat less photosensitive food; arrange sleep reasonably, etc.
1.Treatment with topical drugs
(1) Topical hydroquinone cream (such as thousand white cream, hydroquinone concentration of 2%)
(2) Vitamin A acid cream
(3) L-vitamin C serum (Ximax, L-Vc concentration 23.8%, USA), add two drops in the day cream, night cream, mix well and apply on the face (including around the eyes); also can do ultrasonic import regularly.
(4) Chemical peeling or basic care with three generations of fruit acids (such as Corexit, U.S.)
2.Medication for internal use
May take oral vitamin C. Remember not to take oral/topical vitamin E (photosensitive) in the morning.
Glutathione IV drip (once a day for 15 days, then once a week thereafter). The most important ingredient in the whitening injection is glutathione. Glutathione is a reducing agent, as it can remove toxins and metabolic waste from the body, commonly used in liver protection, post-chemotherapy surgery, and old cadre convalescence. The process of decomposing pigmentation is even the process of tyrosine dehydrogenation and reduction, so glutathione can play the effect of whitening and lightening pigmentation.
3.Laser/intense pulsed light treatment
The fourth generation of intense pulsed light, because its waveform is a square wave like the Great Wall battlements, not a spire-type wave, so there is no energy spike, which cannot cause side effects such as burns, discoloration, skin sensitivity thinning; meanwhile, the energy does not decay to ensure the treatment efficiency. After clinical statistics, the efficiency is around 77.5%.
Q-switched Nd-YAG laser with low energy is more effective for dermal type melasma.
Intense pulsed light/Q-switched Nd-YAG laser sequential therapy is suitable for stubborn melasma. No rebound after treatment.