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Dark discoloration on the skin that appears after exposure to the sun is characteristic. And although there are young women with a darker complexion at risk, this problem can affect anyone.
Chloasma – what is it characterized by?
Chloasma (Latin. melasma, chloasma) is the most common discoloration of the facial skin. It is much less common on the neck. It can be light to dark brown in color.
It most often affects women, although in 10-25 percent. this condition affects men, especially after using hydantoin and mesantoin derivatives. The changes appear most often after the age of 30, in young women with a darker complexion, mainly living in countries with high sun exposure. But not only.
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The causes of chloasma
The exact causes of chloasma are not fully understood. However, it is known about several factors contributing to its formation. The primary factor causing chloasma is exposure to UV radiation.
However, pathological changes occur only in genetically predisposed people, often with the participation of hormonal factors that are associated with pregnancy, the use of oral contraception or hormone replacement therapy (HRT) in postmenopausal women.
If discoloration occurs in a woman during pregnancy, there are over 50 percent. the likelihood that the later use of contraceptive pills, especially estrogen-progestogen pills, will also trigger it.
The skin’s susceptibility to discoloration caused by ultraviolet radiation may also increase under the influence of certain medications, e.g. antiepileptic, antidepressant, antiviral or antiarrhythmic drugs.
The change in skin color in drug discoloration can be influenced by both the increase in the amount of melanin and the deposition of drug metabolism products in the skin. Chloasma can also occur due to the use of some perfumes and deodorants whose ingredients have a photosensitizing effect.
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Photo courtesy of the American Academy of Dermatology
Symptoms of chloasma
Symmetrical, mottled, not well-defined foci of brown discoloration, not preceded by inflammation, are the only symptom of chloasma.
Located in the central part of the face, on the cheeks, above the upper lip, on the nose, forehead and chin, less often on the lateral surfaces of the face and on the dorsal surfaces of the forearms, they intensify in summer. In winter, they become less visible. And although they may disappear spontaneously after childbirth or discontinuation of oral hormonal contraception, they are of a recurrent nature. They usually reappear in the next pregnancy and may last for years.
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Diagnostics with Wood’s lamp
The doctor makes a diagnosis based on the history (important tips are, for example, use of hormonal contraception, intensification of changes under the influence of the sun) and the appearance of skin discoloration.
Determining the depth of the location of the dye is useful in the diagnosis and selection of the treatment method. They are made possible by examining the skin with a Wood’s lamp, which emits long-wave ultraviolet radiation (so-called black light or Wood’s light). Depending on the depth of melanin location, a division into three types of chloasma was adopted.
Treatment of chloasma
Due to the recurrence of lesions, treatment is difficult. The basis of the procedure, regardless of the depigmentation methods used, is protection against both UVA and UVB rays. Patients are advised to, if possible, discontinue contraceptive medications and other photosensitisers.
Treatment consists of the use of decolorizing and exfoliating preparations. In severe changes, decolorization is used with preparations based on hydroquinone, kojic or azaleic acid, often in combination with α-hydroxy acids. In justified cases, decolorizing preparations are used alternately with tretinoin, a derivative of vitamin A.
Chemical exfoliation with high concentrations of glycolic or trichloroacetic acid is used more and more often, as well as laser treatments, mainly CO2.
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