Melazma

Melazma – the acquired high-quality disturbance of a xanthopathy, locally limited more developing in areas of the person and neck. Melazma is shown unevenly in the form of spots on skin from light brown to a dark, black shade. Spots at a melazma have accurate contours, generally are located on open sites of skin. Melazma does not affect mucous membranes. A nevus pigmentosus at a melazma is not shelled, the structure of affected areas of skin does not change. Melazma tends to clarification during the autumn and winter period. During the spring and summer period of the active sun the melazma gets brighter shade. More often women are subject to a melazma. Such type of a hyperpegmentation occurs at men extremely seldom that is caused by a hormonal etiology of this disease. Melazma can be shown both by the single centers of damage of skin, and a set of spots on all open surface of skin (a face, a neck, area of a decollete, a hand).

Melazma types

There are three classifications of a melazma based on clinical, histologic signs and character of a course of a disease.

So, on clinical signs (on localization of manifestations of a nevus pigmentosus) the melazma is divided into three main types:

• Painting – the main centers of damage of skin are localized in cheeks and a nose;
• Central front (tsentrofatsialny) – a nevus pigmentosus is localized in a forehead, a nose, an upper lip, a chin;
• Mandibular – spots of a melazma strike a mandible arch.

On character of a course of a disease of a melazm it is divided on:

• Passing – spots have temporality and disappear completely after the termination of influence of the factor stimulating production of melanin and development of a nevus pigmentosus (hormones, sunshine);
• Persistent – the melazma which is passing from heavier into easier form, but not passing completely.

On histologic signs distinguish:

• Epidermal melazma – increase in amount of melanin in epidermis layers. The light brown shade of spots of a melazma becomes brighter under Wood's lamp;
• Thermal melazma – increase in amount of melanin in superficial and deep layers of a derma. This pathology is characterized by spots of an ashy or bluish-gray shade. Pigmentation does not become brighter under Wood's lamp;
• The mixed melazma – this pathology is characterized by defeat of both superficial epidermal layers, and deep layers of a derma. The spots of a melazma of such genesis of usually dark brown color which are not changing under Wood's lamp.

Reasons of development of a melazma

The major factors defining emergence and development of a melazma are:

• Ultraviolet radiation – UF beams stimulate production of melanin (melanogenesis), and also growth of melanocytes (the cells of skin which are responsible for development of a pigment of melanin);
• Genetic predisposition;
• Sex;
• Disturbance of a hormonal background (reception of hormonal contraceptives, pregnancy, dysfunction of ovaries);
• Abnormal liver function, thyroid gland;
• Digestive tract diseases;
• Therapy by the photosensitizing drugs (stimulating hypersensitivity of skin to influence of ultraviolet rays);
• Disturbance of the exchange processes of an organism provoked by surplus or a lack of minerals and vitamins;
• Use of some cosmetics.

Diagnosis of a melazma

Melazma is shown by only one clinical symptom – group of accurately outlined spots on defined (more often opened) the site of skin. At diagnosis of pathological change for the choice of the correct tactics of treatment the melazma needs to be differentiated with such disturbances having similar symptomatology and external manifestations as:

• Secondary hyperpegmentation;
• Pigmental xeroderma;
• Poykilodermichesky lymphoma of skin;
• Ril's melanosis;
• Nevus.

The main diagnostic method of a melazma – Wood's lamp that allows to classify a melazma.

Melazma: treatment, main methods

Melazma is characterized by resistance to various methods of treatment. It is necessary to remember that the melazma is some kind of reaction of an organism to the irritating factor (excessive radiation, hormonal therapy). At a melazma treatment will be ineffective without elimination of a provocative factor. At passing melazma form treatment is appointed symptomatic, directed to reduction of manifestations of a nevus pigmentosus.

The main techniques of treatment of a melazma are:

• Medicamentous therapy – use of topical drugs which effect is directed to braking and inhibition of a tyrosinase (the enzyme catalyzing synthesis of melanin from tyrosine). The main side effects of topical drugs for treatment of a melazma are the secondary hyperpegmentation, dermatitis, an erythema, burning. This technique is most effective for treatment of an epidermal melazma;
• Injection methods – vnturikozhny administration of the drugs inhibiting a tyrosinase;
• Hardware treatment – use of light methods (lasers, the intensive pulsing installations). Such technique of treatment of a melazma allows to influence selectively the melanin which is contained in the pigmented cells without impact on surrounding healthy cells. Laser correction of a nevus pigmentosus assumes destruction of microsites of skin, on site which then healthy cells with normal pigmentation develop. The main lack of a technique is the increased risk of development of posttraumatic pigmentation of the processed sites of skin. At epidermal and thermal forms of a melazma treatment by hardware techniques is the most effective;
• Chemical peelings – removal of an upper layer of epidermis for the purpose of recovery of process of regeneration of skin and oppression of processes of a melanogenesis. For the purpose of correction of a nevus pigmentosus superficial and middle peelings are applied. Use of deep aggressive peeling techniques for treatment of a melazma is not justified as efficiency of a technique is small in comparison with risk of development of a secondary hyperpegmentation.

Melazma: treatment by Skinoren

At diagnosis of a melazma treatment by Skinoren is one of the most effective techniques which are applied now. Skinoren – the dermatoprotektorny means for external use having depigmenting, antibacterial, keratolytic, and also antiinflammatory effect. The main active ingredient as a part of drug is the azelaic acid making impact on hyperactive melanocytes thanks to braking of a tyrosinase. At a melazma treatment by Skinoren most effectively at early stages of development of a disease. Skinoren is issued in forms of cream and gel with various concentration of active ingredient. At a melazma treatment by Skinoren assumes a course lasting from 3 months. The main side effects of Skinoren are the hyperemia, burning, an itch. Skinoren is effective at an epidermal melazma. The Dermalny melazma will not respond to treatment this drug.