|
Melasma
is an acquired, light or dark brown pigementation seen on the
face, particularly on the cheeks, central forehead, nose and the
upper lip. Causes could be familial, pregnancy, use of oral
contraceptives, certain medicines like phenytoin, menopause,
idiopathic etc. The lesions progress after exposure to sunlight.
Treatment:
The response to treatment depends upon the level of the pigment
and the duration of the pigmentation.
Those developing during pregnancy may disappear spontaneously.
Treatment includes sun screens, hydroquinone,
retinoic acid, azelaic acid, kogic acid, topical vitamin C, chemical peeling etc.
|
|
 |
|
|
Post-inflammatory
hyperpigmentation: It is a common problem in dark
skinned individuals. This can develop following acne,
dermatitis, any type of trauma etc. The response to
treatment is good when the pigmentation is in the
superficial layers of the skin.
Treatment
includes mild topical steroids in early stages followed
by hydroquinone and chemical peeling with
trichloroacetic acid or glycolic acid. Sun screens
containing titanium dioxide should be used daily.
|
Other than
the above mentioned modalities, pigmentation can also be treated
with – Nd-YAG and Q
switched ruby lasers also.
Periorbital
pigmentation (Dark circles around the eyes): It is very common and
often causes concern in patients. Transient pigmentation under the eyes
occurs following lack of sleep, physical strain, mental stress etc.,
which most often clears once the precipitating cause is corrected.
Persistent pigmentation around the eyes could be due to the following:
- Familial
- Atopy
- Eye
strain
- Acanthosis nigricans
- Post inflammatory
(following dermatitis around the eyes)
- Aging
Treatment of
periorbital hyperpigmentation is less satisfactory.
Diffuse hyperpigmentation:
Pigmentation
of the face can be sometimes a part of diffuse hyperpigmentation due to
various causes. A thorough, systemic examination should be undertaken to
look for such conditions:
Properly chosen sun screens
are the mainstay of treatment of pigmentation..
- Mechanical - Friction induced (macular amyloidosis)
- Drug
induced - Minocycline, phenytoin, chlorpromazine, antimalarials,
oral contraceptives, heavy metals like arsenic, antitumor agents like busulfan, bleomycin,
cyclophosphamide etc.
- Endocrinal -
Pregnancy, Addison's disease, thyrotoxicosis
- Nutritional causes -
Vitamin B12 and folate deficiency, anemia, vitamin C deficiency
- Chronic illnesses -
renal failure, cirrhosis of liver, malabsorption syndromes
- Collagen vascular
diseases - scleroderma [See],
SLE [See], dermatomyositis
- Neoplasms - Tumors
of pituitary origin, lymphomas, pheochromocytoma
- Photosensitizing
dermatoses - Pellagra, drugs, porphyria
Treatment
of diffuse hyperpigmentation includes treatment of underlying causes
along with use of sunscreens and depigmenting agents like hydroquinone,
azelaic acid, kogic acid, retinoic acid, glycolic acid and chemical
peeling. Response to treatment may be partial. |
