Rn faces Skin classic, Manual

Page: 37 / 43

The incidence of melasma also increases in patients with thyroid disease. It is thought that
the overproduction of melanocyte-stimulating hormone (MSH) brought on by stress can
cause outbreaks of this condition. Other rare causes of melasma include allergic reaction
to medications and cosmetics.
Melasma Suprarenale (Latin - of the adrenals) is a symptom of Addison's disease,
particularly when caused by pressure or minor injury to the skin, as discovered by Dr.
FJJ Schmidt of Rotterdam in 1859.
Diagnosis
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. By this technique melasma can be divided into
two types 1) epidermal 2) mixed (ep dermal). This diffrentiation is important
for planning of management.
Treatment
The discoloration usually disappears spontaneously over a period of several months after
giving birth or stopping the oral contraceptives or hormone replacement therapy. In cases
without definite causes, the lesions may persist for many years. In cases that severity of
lesions justify the treatment, the following are the common treatment methods available:
1) Avoiding of exposure to strong sunlight (ultraviolet range) with UVA-blocker sunscreen
(320-400 nm) prevention. Since UVA is the most important wavelength of sunlight that
stimulate hyperpigmentation. The over the counter UVA-sunscreen with PA more than +++
and SPF more than 30 is recommended. 2)Reduction of melanin synthesis, the most
commonly use drug is hydroquinone 2-4% . To enhance effectiveness, 4% hydroquinone is
combined with tretinoin (0.05%) and steroids (fluocinolone acetonide 0.01%) and has
been named Kligman's formula. This formula had been proved to be the most effective in
clearing of epidermal melasma. More than 60% will have complete clearing by three
months. The problem of this formula is its long term side effects.