Chloasma is a focal hyperpigmentation of the skin of various sizes, located most often on the face and having clear boundaries. Chloasma has the appearance of a spot of light brown, brown or brownish color. It can be multiple in nature. The diagnosis is established according to the typical clinical picture and localization of pigmentation, additionally, a siascopy, dermatoscopy is performed, the condition of the liver, gynecological sphere and gastrointestinal organs are examined. Treatment of chloasma is reduced to the use of cosmetic methods to reduce the saturation of its color. Exfoliating and bleaching agents, dermabrasion, laser peeling, photo rejuvenation, mesotherapy and cryotherapy are used.
At its core, chloasma (melasma) is an acquired pigment spot. Its formation is caused by excessive deposition of melanin pigment in a limited area of the epidermis and the dermis located under it. Along with freckles, age-related pigmentation and secondary hyperpigmentation after burns and deep dermatitis, chloasma is one of the most common skin pigmentation disorders. In women, chloasma occurs much more often than in men (90% and 10%, respectively). A wider prevalence of melasma is noted among the peoples of the Asian and Eastern groups.
To date, clinical dermatology cannot name the exact causes of the appearance of chloasma. Most researchers tend to believe that the excessive deposition of melanin in chloasma is caused by endocrine and metabolic disorders occurring in the body. This point of view is confirmed by the frequent occurrence of chloasm in the following groups of people:
- patients with chronic liver diseases (viral hepatitis B, chronic hepatitis, cirrhosis of the liver);
- women with inflammatory processes of the gynecological sphere (adnexitis, salpingitis, oophoritis, endometritis) or using drugs for oral contraception;
- persons experiencing excessive exposure to the skin of sunlight or artificial sources of ultraviolet light (for example, with frequent visits to the solarium);
- using cosmetics containing salicylates, linoleic acid, preservatives.
Chloasma is an enhanced pigmentation of a limited area of the skin. It has clear uneven borders and does not rise above the surrounding skin. The color of the chloasma can vary within different shades of brown: light brown, yellowish, dark brown, brownish brown. The size of the chloasma varies greatly. In some cases, it is no more than 1 cm in diameter, in others, chloasma can occupy entire areas on the face.
The favorite location of chloasm is the skin of the face: forehead, upper lip, nose bridge, cheeks, periorbital area. The skin of the eyelids and chin, as a rule, is not affected. In more rare cases, chloasmas occur on the inner surface of the thighs, in the midline of the abdomen and on the chest. Pigmentation often has a single isolated character, but can be multiple and merge with each other at close proximity, forming quite extensive pigmented zones. The appearance of chloasm is not accompanied by itching or soreness. Aesthetic and psychological discomfort is the only subjective sensation that chloasma delivers to the patient.
Separately, there are perinatal chloasma of girls and pigmented perinatal dermatosis, which are observed mainly in females. These diseases are characterized by the appearance of symmetrical brown spots around the mouth. Typically, a long course, a change in the saturation of pigmentation over time and the occurrence of similar pigmentation on the skin of the nasolabial folds and chin.
Chloasma also includes a “pigmented line” – dyschromia, which looks like a pigmented strip 10 mm wide, running through the forehead and sometimes through the cheek reaching the side of the neck. This variant of chloasma is often the first sign of severe damage to the nervous system (brain tumors, Parkinson’s disease, syringomyelia, meningovascular syphilis).
In the countries of Asia, “bronze chloasma” is widespread, which received this name due to a specific bronze staining. It is found both among the indigenous population and among Europeans living in Asia. When the latter move back to their homeland, there is a gradual decrease in the intensity of chloasma coloration and its spontaneous disappearance.
To diagnose chloasma, it is enough for a dermatologist to conduct an examination of the formation, during the survey to exclude its congenital or post-inflammatory nature. Siascopy and dermatoscopy allow us to determine the prevalence and depth of chloasma, which is important for choosing a treatment method.
When detecting chloasma, a number of additional examinations are necessary aimed at examining the gastrointestinal tract and liver of the patient. These include:
- biochemical liver tests, coprogram, analysis for dysbiosis;
- gastroscopy, ultrasound of the abdominal cavity and ultrasound of the liver;
- women are recommended to consult a gynecologist to exclude diseases of the sexual sphere and the selection of contraception.
Differential diagnosis of chloasma is carried out with professional melasma, secondary hyperpigmentation, Mongolian spot, borderline pigment nevus, with especially large sizes of chloasma — with a giant pigment nevus.
Patients with chloasma are advised to avoid excessive ultraviolet radiation and use sunscreens with SPF 25-30. Correction of existing metabolic and hormonal disorders is necessary. In order to normalize melanin metabolism, vitamin therapy is prescribed: ascorbic and folic acid, riboflavin, B vitamins.
It should be noted that there are no specific methods for correcting pigment metabolism or removing chloasmas yet. In the treatment, mainly cosmetic methods are used to reduce the intensity of pigmentation. They have two directions: reduction of melanin production in the skin and exfoliation of the stratum corneum of the epidermis in the pigmentation zone.
The following groups of substances contribute to the reduction of melanin formation: tyrosinase inhibitors (kojic acid, arbutin); inhibitors of pigment synthesis in melanocytes (azelaic acid, hydroquinone); derivatives of vitamin C. Most of these substances are toxic, especially hydroquinone. However, their use continues, as it gives a noticeable effect. These products are part of various whitening creams and ointments. Sulfur ointments and white sedimentary mercury also have a bleaching effect.
Methods of professional cosmetology
Exfoliating agents include: citric and lactic acid, alpha-hydroxy acids, glycolic acid. These substances are used for chemical peeling. When chloasma is used:
- glycolic peeling;
- TSA peeling;
- phenolic peeling.
Hardware methods give a good effect: dermabrasion, laser peeling. The elimination of chloasma, as well as other pigmentation, is facilitated by photo rejuvenation, laser cosmetology, cryomassage, Biorevitalization of the skin with the use of hyaluronic acid and mesotherapy with whitening cocktails lead to normalization of skin metabolic processes, including pigmentation.
All methods used in the treatment of chloasma require repeated and complex application. With chloasma of pregnant women, it is better not to carry out treatment, because during this period there are a lot of contraindications, and after childbirth such chloasma usually passes on its own.