Melasma
Melasma, also known as liver spots, is a yellowish-brown pigmentation on the face. It is mostly distributed on the cheeks in a symmetrical butterfly shape. It is mostly seen in women, and the high level of estrogen in blood is the main cause. Its onset is related to pregnancy, long-term oral contraceptive use and menstrual disorders.
Etiology of melasma
The appearance of chloasma is mostly related to endocrine, especially the estrogen level of women, menstrual disorders, pregnancy, contraceptive pills or poor liver function and chronic kidney disease may appear chloasma. In addition, sun exposure and mental factors can also aggravate the disease. Chloasma often appears in pregnant women after the third month of pregnancy, and most of them gradually fade away after delivery when menstruation returns to normal. If it does not subside for a long time, treatment is needed.
Clinical manifestations of melasma
The damage is yellow-brown or dark brown patches, often symmetrically distributed on the cheek and cheek area, and may also involve the periorbital area, forehead, upper lip and nose, with generally more obvious edges. There are no subjective symptoms and general discomfort. The shades of pigmentation are related to season, sunlight and endocrine factors. Mental stress, staying up late and exertion may aggravate the lesions.
Diagnosis of melasma
It can be diagnosed according to the yellow-brown rash, which is mostly seen in young and middle-aged women and the location of its occurrence, and should be distinguished from freckles, Reye’s melanosis, nevus of Ota, and zygomatic brown nevus.
Melasma treatment
1.Local treatment
(1) Topical medication
It is the simplest and most commonly used treatment method. Topical tyrosinase inhibitor ointment, such as 5% hydroquinone cream, 2-4% tretinoin cream and 3% arbutin. All of them have different degrees of efficacy after application. These drugs are antioxidants and are easily oxidized in air and sunlight, so they should be kept closed and protected from light. In recent years, it has been reported that 0.1% retinoic acid ointment is used to treat chloasma, and topical glucocorticoids also have certain efficacy.
(2) Exfoliation therapy
Local application of trichloroacetic acid solution can make the epidermis peel off and remove the pigment spots. Liquid nitrogen freezing treatment can make the epidermis freeze and necrosis and then peel off to remove pigment, and grinding surgery is to remove the epidermis with a grinding head to remove pigment. After the surgery, sunscreen can be applied after the wound is healed, otherwise it is easy to recur after sun exposure.
(3) Mask therapy
Mask therapy includes simple mask agent, mask cream massage method and inverse mask method. Among them, the inversion mask method has been widely used in the treatment of melasma, and has achieved satisfactory results. Mask inversion therapy integrates medicine, massage and physiotherapy, thus having multiple therapeutic effects. The treatment procedure is: cationic steam moistening – mask cream massage – forming inversion agent inversion. The drug composition of the mask cream plays a key influence on the treatment of melasma. At present, there are mask creams for pigment removal, whitening mask creams and herbal masks specializing in melasma treatment.
(4) Laser or intense pulsed light treatment Recently, the application of photorejuvenation and Q-switched laser have been reported to be effective in treating some patients with melasma.
2.Systemic treatment
Vitamin C: In order to promote pigment reduction, vitamin C can be used, preferably by intravenous injection.
Melasma prevention
Because sunlight has a certain relationship with the onset or aggravation of the disease, so attention should be paid to sun protection, when you go out, you can apply creams containing light-avoiding agents (such as 5% titanium dioxide cream, 5% salicylic acid benzoic acid ointment) or hold a sunshade, etc. Pay attention to rest, avoid staying up late and nervous.