Melasma: Sometimes also called chloasma, the mask of pregnancy. Melasma is a light brown discoloration with indistinct boundaries and variable appearance on the skin of the face centered on the cheekbones. In most cases, it is symmetrically distributed from left to right, and sometimes it can appear on the forehead and lips. It can also appear on the protruding part of the jaw bone. It is more common in people of color (Hispanic, Southeast Asian, etc.). It is predominantly found in women and occasionally in men. It is an acquired hyperpigmentation disorder with an age of onset between 20-40 years. Pregnancy and sun exposure can worsen the lesions (but this is a common phenomenon of facial pigmentation and not specific to melasma). Its symptoms can change over time.
Clinical diagnosis and efficacy criteria of chloasma (revised in 2003 by Pigmentology Group of Dermatological and Venereal Diseases Committee of Chinese Society of Integrative Medicine)
A clinical diagnosis criteria
①Light brown to dark brown, well-defined patches on the face, usually symmetrically distributed, without inflammatory manifestations and scaling. ②No obvious self-conscious symptoms. ③More frequent in females, mainly occurring after puberty. ④The condition can be seasonal, often heavy in summer and light in winter. ⑤Exclude pigmentation caused by other diseases (such as zygomatic nevus, Riehl’s melanosis and pigmented flatulent moss).
Clinical typing
(a) There are 4 types of lesions according to the site of occurrence. ① Butterfly-shaped type: the lesions are mainly distributed on both sides of the cheeks and are symmetrically distributed in the shape of a butterfly. (2) Facial type (lesions are mainly distributed in the forehead, temporal area, nose and cheek area. ③Subfacial type: lesions are mainly distributed in the lower cheeks and around the mouth. (iv) Generalized type: the lesions are distributed over a large area of the face.
(2) Two types according to the cause: ① idiopathic type: no obvious cause. (2) Secondary type: caused by pregnancy, menopause, oral contraceptives, sunlight, etc.
Our diagnostic criteria: ①After 16 years of age, acquired facial pigmentation, often appearing in the cheekbones, forehead and around the mouth and lips.
②Brown, diffuse discoloration, sometimes with a reticulated appearance. The borders are indistinct, but sometimes appear in some specific areas (e.g., the upper edge of the cheekbone and orbital rim are consistent in a linear pattern)
③Symptoms may vary.
④More common in females.
⑤ Basically there is no trauma and other triggers, but sometimes traumatic hyperpigmentation will be transformed into melasma.
⑥In hairy parts such as within the hairline, eyebrows and other parts usually do not grow.
Treatment: Melasma is an incurable disease, but it is not painful, has no self-conscious symptoms, and only affects the beauty of the face. Many patients give up the treatment due to lack of self-discipline, trouble and lack of confidence. As people’s living standard improves, they start to pay more attention to the quality of life and beauty and health than just food and clothing, and their demand for melasma treatment rises. But at this stage, there is really no exact treatment that can quickly lighten the spots and avoid recurrence. Therefore, the treatment of melasma is comprehensive and multifaceted.
1.Conservative treatment of Gussy style. Preferred treatment. When visiting the doctor, you should remove makeup thoroughly and take pictures for a comprehensive departmental diagnosis. Come to the hospital once a month for follow-up, observe and record the changes, check whether there is regular avoidance of light, sun protection, medication, develop good living habits, do not rub the skin hard, prohibit all cosmetic operations on the affected area (massage, fumigation, peeling, etc.), avoid light exactly, and be told that about 90% of melasma can lighten and shrink or even disappear in 1.5 years.
2.Oral tranexamic acid (torsemide). Exclude contraindication of oral medication by outpatient visit examination, check clotting time, etc. and monitor. Take under the guidance of a doctor. 500mg per day, divided into two doses, one in the morning and one in the evening. 1-2 months to begin to show results, the course of treatment in about a year to a year and a half. Irregular dosing or premature discontinuation of the drug can lead to relapse.
What groups of people are contraindicated to be treated with tranexamic acid?
Pregnant and breastfeeding women, elderly patients, patients on long-term oral contraceptives, patients with poor liver or kidney function, patients with coronary artery disease, thrombophilia, patients with coagulation problems, patients taking blood-thinning drugs such as aspirin and clopidogrel, and patients with too high expectations of efficacy should not be treated with tranexamic acid.
Adverse effects of tranexamic acid: nausea, vomiting, decreased menstrual flow, diarrhea, skin irritation, thromboembolism, etc.
3.White porcelain doll. Weak Q-switched 1064 laser treatment. Once or twice a month, strict sun protection and light avoidance during the treatment period, combined with the treatment of human-like collagen mask after the treatment.
4, IPL. risky, high energy but discoloration, other methods are ineffective or poor results can be tried. Need to combine with tranexamic acid oral or whitening injection treatment.
5.Other internal medicine: mixture of vitamin E and vitamin C; glutathione; Chinese herbal medicine treatment? Psychiatry treatment?
6.Treat and avoid irritating factors: gynecological diseases, liver diseases, sleep disorders, irritability, temper tantrums, obesity lack of exercise, etc.