MelasmaReem Ahmed Alyahya

212522156

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.

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

Differential Diagnosis

Melasma Post inflammatory hyperpigmentation

Actinic lichen planus Riehl melanosis

Most likely Diagnosis:

Melasma

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.

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

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.

ManagementBleaching agents ( Hydroquinone, azelaic acid , and tretinoin)

Chemical peels (glycolic acid )

Laser

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.

Thank you

References:

Fitzpatricks Color Atlas and Synopsis of Clinical Dermatology, 7th Edition.

Uptodate Medscape BMJ