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Notes form sources
two types of melasma epidermal (increased melanin pigmentation in the suprabasal layers of the epidermis) and dermal (increased melanin in the dermal macrophages, with associated milder epidermal hyperpigmentation)

dermal kind is less responsive to common treatments and appears darker than the epidermal type when looked at with a woods lamp

treatment is often unsatisfying and has effects such as: irritation, scarring, contact dermatitis, and patches of lighter skin (confetti pigmentation)

most commonly affects Hispanic and asian people that live in areas with high exposer to uv rays.

Evidence-Based Dermatology, edited by Michael Bigby, and Andrew Herxheimer, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/uwm/detail.action?docID=1708797.

African, asian, or hispanic decent with Fitzpatrick skin type III or greater are at a higher risk

lesions .5 cm to larger than 10cm in diameter

three location categorizes: centrofacial (most common on forehead, checks, upper lip, nose, and chin), malar (at nose and checks), and mandibular (at bilateral rami)

another treatment:

kojic acid: over the counter in 2%

Arndt, Kenneth A., et al. Manual of Dermatologic Therapeutics (Lippincott Manual Series), Wolters Kluwer, 2014. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/uwm/detail.action?docID=2031621.

edits to original article
treatment list:


 * Cysteamine hydrochloride (5%) over-the-counter. Mechanism of action seems to involve inhibition of melanin synthesis pathway
 * Kojic acid (2%) over-the-counter.
 * Flutamide (1%)
 * Chemical peels

Treatment:

In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc dioxide is preferred over that with only chemical blockers. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

There are many negative side effects that go along with these treatments and many times treatments are unsatisfying overall. Things such as scarring, irritation, lighter patches of skin, and contact dermatitis are all commonly seen to occur.

Patients should avoid other precipitants including hormonal triggers.

signs and symptoms:

The symptoms of melasma are dark, irregular well demarcated hyperpigmented macules to patches. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. Patches can vary in size from 0.5 cm to larger than 10cm depending on the person. The location of melasma can be categorizes as centrofacial, malar, or mandibular. The most common is centrofacial in which patches appear on the checks, nose, upper lip, forehead, and chin. The mandibular category accounts for patches on the bilateral rami, while the malar location accounts for patches on only on the nose and checks.

diagnosis:

There are two types of melasma, epidermal and dermal. Epidermal melasma results from melanin pigment that is elevated in the suprabasal layers of the epidermis. Dermal melasma occurs when the dermal macrophages have an elevated melanin level. Melasma is usually diagnosed visually or with assistance of a Wood's lamp (340 - 400 nm wavelength). Under Wood's lamp, excess melanin in the epidermis can be distinguished from that of the dermis. This is done by looking at how dark the melasma appears, dermal melasma will appear darker than epidermal melasma under the Wood's lamp.

cause:

Genetic predisposition is also a major factor in determining whether someone will develop melasma. People living in areas of high UV light exposer with the Fitzpatrick skin type III or greater and are from an African, Asian, or Hispanic decent are at a much higher risk than others. In addition women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.