User login
The FP diagnosed melasma (mask of pregnancy) in this patient. Melasma is a relatively common disorder that affects sun-exposed areas of skin—most commonly the face. The actual incidence is unknown, but it is believed to affect up to 75% of pregnant women. It is particularly prevalent in women with darker skin types (especially Hispanics) who live in warm sunny regions.
Melasma is a localized facial hyperpigmentation most commonly caused by pregnancy or the use of oral contraceptive pills along with sun exposure. Melasma in men is much less common, but shares the same clinical features as are seen in women. Melasma due to pregnancy usually regresses within a year of giving birth, but areas of hyperpigmentation may never completely resolve. As was the case with this patient, melasma may increase with each subsequent pregnancy.
The treatment of melasma is not always effective. The main topical treatment options include tretinoin cream applied once daily at bedtime or hydroquinone (2% over the counter, 4% by prescription). Combining tretinoin and hydroquinone can potentiate their effects.
A new medication that contains tretinoin 0.05%, hydroquinone 4%, and fluocinolone acetonide 0.01% (Tri-Luma) has been effective in the treatment of melasma. Azelaic acid (20%) twice daily, kojic acid formulations, and alpha-hydroxy acids have also been useful in the treatment of melasma.
Side effects of all topical treatments include allergic and contact dermatitis, depigmentation of surrounding normal skin, and postinflammatory hyperpigmentation. Tretinoin should not be used during pregnancy. If hydroquinone is prescribed, it’s important to warn patients to stop using it immediately if the hyperpigmentation increases. Also, if there has been no benefit after 3 months, hydroquinone should be stopped. All patients should be advised to use sun protection.
In this case, the patient indicated that while she hoped the pigment would fade, she did not want to treat the melasma. She was, however, willing to use sun protection to avoid worsening the existing hyperpigmentation.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Melasma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:845-848.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The FP diagnosed melasma (mask of pregnancy) in this patient. Melasma is a relatively common disorder that affects sun-exposed areas of skin—most commonly the face. The actual incidence is unknown, but it is believed to affect up to 75% of pregnant women. It is particularly prevalent in women with darker skin types (especially Hispanics) who live in warm sunny regions.
Melasma is a localized facial hyperpigmentation most commonly caused by pregnancy or the use of oral contraceptive pills along with sun exposure. Melasma in men is much less common, but shares the same clinical features as are seen in women. Melasma due to pregnancy usually regresses within a year of giving birth, but areas of hyperpigmentation may never completely resolve. As was the case with this patient, melasma may increase with each subsequent pregnancy.
The treatment of melasma is not always effective. The main topical treatment options include tretinoin cream applied once daily at bedtime or hydroquinone (2% over the counter, 4% by prescription). Combining tretinoin and hydroquinone can potentiate their effects.
A new medication that contains tretinoin 0.05%, hydroquinone 4%, and fluocinolone acetonide 0.01% (Tri-Luma) has been effective in the treatment of melasma. Azelaic acid (20%) twice daily, kojic acid formulations, and alpha-hydroxy acids have also been useful in the treatment of melasma.
Side effects of all topical treatments include allergic and contact dermatitis, depigmentation of surrounding normal skin, and postinflammatory hyperpigmentation. Tretinoin should not be used during pregnancy. If hydroquinone is prescribed, it’s important to warn patients to stop using it immediately if the hyperpigmentation increases. Also, if there has been no benefit after 3 months, hydroquinone should be stopped. All patients should be advised to use sun protection.
In this case, the patient indicated that while she hoped the pigment would fade, she did not want to treat the melasma. She was, however, willing to use sun protection to avoid worsening the existing hyperpigmentation.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Melasma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:845-848.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
The FP diagnosed melasma (mask of pregnancy) in this patient. Melasma is a relatively common disorder that affects sun-exposed areas of skin—most commonly the face. The actual incidence is unknown, but it is believed to affect up to 75% of pregnant women. It is particularly prevalent in women with darker skin types (especially Hispanics) who live in warm sunny regions.
Melasma is a localized facial hyperpigmentation most commonly caused by pregnancy or the use of oral contraceptive pills along with sun exposure. Melasma in men is much less common, but shares the same clinical features as are seen in women. Melasma due to pregnancy usually regresses within a year of giving birth, but areas of hyperpigmentation may never completely resolve. As was the case with this patient, melasma may increase with each subsequent pregnancy.
The treatment of melasma is not always effective. The main topical treatment options include tretinoin cream applied once daily at bedtime or hydroquinone (2% over the counter, 4% by prescription). Combining tretinoin and hydroquinone can potentiate their effects.
A new medication that contains tretinoin 0.05%, hydroquinone 4%, and fluocinolone acetonide 0.01% (Tri-Luma) has been effective in the treatment of melasma. Azelaic acid (20%) twice daily, kojic acid formulations, and alpha-hydroxy acids have also been useful in the treatment of melasma.
Side effects of all topical treatments include allergic and contact dermatitis, depigmentation of surrounding normal skin, and postinflammatory hyperpigmentation. Tretinoin should not be used during pregnancy. If hydroquinone is prescribed, it’s important to warn patients to stop using it immediately if the hyperpigmentation increases. Also, if there has been no benefit after 3 months, hydroquinone should be stopped. All patients should be advised to use sun protection.
In this case, the patient indicated that while she hoped the pigment would fade, she did not want to treat the melasma. She was, however, willing to use sun protection to avoid worsening the existing hyperpigmentation.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Melasma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:845-848.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link: