Gestational “birthmarks”, also known as melasma, butterfly spots or hyperpigmentation. This is caused by pregnancy. Because of endocrine changes during pregnancy, most pregnant women have deepened skin coloring on nipples, areolas, midline of abdomen and pubic area, the degree of which varies from person to person; the color of existing moles also deepens. After the fourth month of pregnancy, some pregnant women have brown spots on their face, which are distributed on the bridge of the nose and cheeks, and also on the forehead in the shape of a butterfly, called “pregnancy spots”.
The cause is still not clear, and there is no special treatment method.
I. Etiology: It is not clear yet.
Possible factors
1.Heredity: 30%-70% of family inheritance Male: Female = 1:92.
2. Endocrine: (pregnancy and oral contraceptives are related to about 50%) estrogen can stimulate melanocytes to secrete melanin granules, and progesterone can promote the transport of melanosomes and increase the amount of melanin. Melanocytes on the face of melasma patients may be highly sensitive to hormonal changes, and as long as there is a small change in estrogen/progesterone level it can have an effect on sensitive melanocytes. Improvement after menopause. The pituitary function of those with poor sleep and mood is affected by it, which leads to ovarian secretion through the hypothalamus-pituitary-ovarian axis
3, cosmetics or inappropriate cosmetic treatments.
4, drugs (phototoxicity, such as anti-epileptic drugs)
5, sun exposure: sunlight exposure increases vitamin D3 and the amount of tyrosinase in melanocytes. UV radiation stimulates keratinocytes to produce and secrete endothelin 1 (endothelin1), which acts on melanocytes and accelerates the proliferation of melanocytes.
6, microecological imbalance: the lesion area transient bacteria such as rods and pigment-producing micrococci increased significantly, producing brown, orange micrococci with the temperature of pigment production changes.
Clinical diagnostic criteria developed in China.
(1) Light brown to dark brown well-defined patches on the face, usually symmetrically distributed, without inflammatory manifestations and scaling.
(2) No obvious self-conscious symptoms.
(3) Occurs mainly after puberty, with a high incidence in females.
(4) The disease has a certain seasonality, heavy in summer and light in winter.
(5) No obvious endocrine diseases, and exclude other diseases caused by hyperpigmentation.
(6) The average optical density value of pigmentation along the area is more than 20% of the average optical density value of its own face.
Therefore, yellow river spot can be regarded as a response of the physiological and psychological state of the body.
Clinical typing.
1. According to the occurrence of lesions, there are 4 types.
(1) Butterfly type: The lesions are mainly distributed on the cheeks, with a butterfly-shaped symmetrical distribution.
(2) Facial type: lesions are mainly distributed in the forehead, temporal area, nose and cheeks.
(3) Subfacial type: lesions are mainly distributed on the lower cheeks, perioral area and lips.
(4) Generalized type: the lesions are widespread in most areas of the face.
2. There are 2 types according to the etiology.
(1) idiopathic type: no obvious cause can be identified.
(2) Secondary type: caused by pregnancy, menopause, oral contraceptives, sunlight exposure, etc.
III. Treatment.
There is still no specific effective treatment drugs, and the treatment can be given according to different causes.
Principles.
1, inhibit the activity of melanocytes, avoid sun exposure or aggravating factors (oral contraceptives).
2, inhibit melanin synthesis, depigmentation agents (phenols “hydroquinone 5% – 3%), triplet: hydroquinone 5% + retinoic acid 0.25% + hydrocortisone 1%. In recent years, it was found that long-term oral administration with small doses of tranexamic acid (torsemide) is also more effective.
3.Removal of melanin, chemical peeling Suitable for light-skinned people Hydroxyethylic acid.
4.Destruction of melanin, laser Photorejuvenation is effective, but the effect is not certain.
Current treatment options.
1, personal adjustment (sleep, psychological, emotional, endocrine).
2, oral medication (triplex).
3, topical medication (hydroquinone cream).
4.Photon + laser skin purification.
At the same time, patients should recognize the complexity of melasma occurrence, the long-term nature of its treatment and the difficulty of eradication, and be calm and peaceful. The specific choice should be made according to each person’s way.