Download - Melasma
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MelasmaReem Ahmed Alyahya
212522156
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Case history:
A 25-year-old woman with Fitzpatrick type IV skin complains of a darkening of the skin on her cheeks, nose, upper lip and forehead that began 7 months ago during her first pregnancy.
The lesions are asymptomatic “ not pruritic nor painful “, and they’re exacerbated by sun exposure.
No history of atopy or other skin diseases. There’s no history of new cosmetics usage.
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Case history: examination• hyperpigmented “
brownish “ macules located on the cheeks, nose, forehead and upper lip.
• Bilateral, symmetrical, well demarcated, with irregular shapes , smooth surface and variable pigment intensity.
• size ranges 5-7 cm
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Differential Diagnosis
Melasma Post inflammatory hyperpigmentation
Actinic lichen planus Riehl melanosis
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Most likely Diagnosis:
Melasma
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Melasma
Greek: “a black spot” it is an acquired light- or dark-brown
hyperpigmentation that occurs in the exposed areas, most often on the face, and results from exposure to sunlight.
Clinically, Melasma has 3 typical patterns: Centrofacial ,malar and mandibular
Histologically, it can be subtyped into: epidermal, dermal and mixed.
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Diagnosis:
Wood lamp:
melasma that accentuates with Wood lamp examination is generally more epidermal in location, whereas melasma that does not accentuate is more likely to be dermal in location
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Management
The treatment of melasma can be challenging because of the chronic and persistent nature of this condition.
Intermittent long-term topical therapy and strict sun protection are often necessary to control the disease.
Regardless of the method chosen, therapy must be combined with use of broad spectrum sunscreens.
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ManagementBleaching agents ( Hydroquinone, azelaic acid , and tretinoin)
Chemical peels (glycolic acid )
Laser
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Back to our case:
azelaic acid 15-20% topical apply to the affected area(s) twice daily.
Sun protection: Broad spectrum sunscreen to be applied to the face every morning, with re-application every 2 hours during intense sun exposure.
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Thank you
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References:
Fitzpatricks Color Atlas and Synopsis of Clinical Dermatology, 7th Edition.
Uptodate Medscape BMJ