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MELASMA
Definition:
Melasma is a very common patchy brown, tan, or blue-gray facial skin discoloration, almost entirely seen in women in the reproductive years. It typically appears on the upper cheeks, upper lip, forehead, and chin of women 20-50 years of age. Although possible, it is uncommon in males. It is thought to be primarily related to external sun exposure, external hormones like birth control pills, and internal hormonal changes as seen in pregnancy. Most people with melasma have a history of daily or intermittent sun exposure. Melasma is most common among pregnant women, especially those of Latin and Asian descents. People with olive or darker skin, like Hispanic, Asian, and Middle Eastern individuals, have higher incidences of melasma.
An estimated 6 million women are living in the U.S. with melasma and 45-50 million women worldwide live with melasma; over 90% of all cases are women. Prevention is primarily aimed at facial sun protection and sun avoidance. Treatment requires regular sunscreen application and fading creams.

Causes :
The exact cause of melasma remains unknown. Experts believe that the dark patches in melasma could be triggered by several factors, including pregnancy, birth control pills, hormone replacement therapy (HRT and progesterone), family history of melasma, race, antiseizure medications, and other medications that make the skin more prone to pigmentation after exposure to ultraviolet (UV) light. Uncontrolled sunlight exposure is considered the leading cause of melasma, especially in individuals with a genetic predisposition to this condition. Clinical studies have shown that individuals typically develop melasma in the summer months, when the sun is most intense. In the winter, the hyperpigmentation in melasma tends to be less visible or lighter.
When melasma occurs during pregnancy, it is also called chloasma, or "the mask of pregnancy." Pregnant women experience increased estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels during the second and third trimesters of pregnancy. However, it is thought that pregnancy-related melasma is caused by the presence of increased levels of progesterone and not due to estrogen and MSH. Studies have shown that postmenopausal women who receive progesterone hormone replacement therapy are more likely to develop melasma. Postmenopausal women receiving estrogen alone seem less likely to develop melasma.
In addition, products or treatments that irritate the skin may cause an increase in melanin production and accelerate melasma symptoms.
People with a genetic predisposition or known family history of melasma are at an increased risk of developing melasma. Important prevention methods for these individuals include sun avoidance and application of extra sunblock to avoid stimulating pigment production. These individuals may also consider discussing their concerns with their doctor and avoiding birth control pills and hormone replacement therapy (HRT) if possible.

Clinical features:
Melasma is characterized by discoloration or hyperpigmentation primarily on the face.
Three types of common facial patterns have been identified in melasma, including
1. centrofacial (center of the face),
2. malar (cheekbones),
3.and mandibular (jawbone).
The centrofacial pattern is the most prevalent form of melasma and includes the forehead, cheeks, upper lip, nose, and chin. The malar pattern includes the upper cheeks. The mandibular pattern is specific to the jaw.
The upper sides of the neck may less commonly be involved in melasma. Rarely, melasma may occur on other body parts like the forearms. One study confirmed the occurrence of melasma on the forearms of people being given progesterone. This was a unique pattern seen in a Native American study.



Types of melasma
Four types of pigmentation patterns are diagnosed in melasma:
1. epidermal,
2. dermal,
3. mixed,
4.and an unnamed type found in dark-complexioned individuals.
The epidermal type is identified by the presence of excess melanin in the superficial layers of skin. Dermal melasma is distinguished by the presence of melanophages (cells that ingest melanin) through out the dermis. The mixed type includes both the epidermal and dermal type. In the fourth type, excess melanocytes are present in the skin of dark-skinned individuals.

Diagnosis:
Melasma is usually readily diagnosed by the typical appearance of brown skin patches on the face. Dermatologists are physicians who specialize in skin disorders and often diagnose melasma by visually examining the skin. A black light or Wood's light (340-400 nm) can assist in diagnosing melasma. In most cases, mixed melasma is diagnosed, which means the discoloration is due to pigment in the dermis and epidermis. Rarely, a skin biopsy may be necessary to help exclude other causes of this local skin hyperpigmentation.

Homeopathy approach:
This term of course means excess of pigment resulting in dark discolorations, but the altered tint of skin may be blue, yellowish, or black, hence the terms of cyanoderma, xanthoderma, and melasma. Melasma Melasma, or that condition in which the discoloration of skin, is black in color, is general or partial. The latter is generally called melasma. The varieties of melasma are lentigo and ephelis. These spots may vary in shape size and colour. In other words these spots may have yellowish -brown or fawn colour (a light brown colour) or dark brown - blackish colour (melanoderma or melasma) resembling with the colour of liver - thus called as liver spots. It is also called as melano-derma or melasma- (melano or melas-means black and derma means skin). It is characterised by the occurrence of extensive brown or darkbrown patches of irregular shape and size on the skin of the face and elsewhere.
Melasma (liver spots, moth patches, melasma, melanoderma) deposit of pigment in the skin, occurring in patches of various sizes and shapes and of a yellow, brown, or black color. In the repertory see ‘discoloration, spots’.

Remedies:
CP6X, KP3X, NM3X, NS3X, Sil - 12X - 2-4 grains dose, be given in alternation with indicated Homeo Medicine - in all cases of chloasma - with dark brown, liver spots on face, cheeks after or during pregnancy with weakness and debility.
Caulophyllum, :
. Chloasma in women, especially who are having uterine troubles and menstrual disorder, weak uterus, profuse leucorrhoea, menses scanty, irregular with spasmodic pains from uterus to all directions -rheumatic pains in smaller joints.
Sepia- .
Chlorosis with chloasma-liver spots over face, cheeks or nose. Patient feels uneasiness in crowd, among strangers with sudden flushing (reddening of face) and palpitation of heart. Women patients have dreamful sleep, bearing down sensation as if every thing would pass out of the genitals - with soreness, swelling and itching of vulva. Such patients feel nausea from the smell of food. Menses irregular too early or scanty.

Remedies for chloasma:
Acet ac, Ant c, Arg n, Bac, Calc c, Carbo v, Card m, Caul, Condur, Con, Fluor ac, Graph, Iod, Laur, Lyc, Nat c, Nat m, Nit ac, Nux m, Petrol, Phos, Puls, Radium, Sep, Sul, Thuja.
Chloasma - Lyc., Nux., Sulph., Curare.

I invite all share ur experience in this..

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Replies to This Discussion

i had a case of women with aged 27. had two childen.. her periods was normal and regular.. complaints developed after one of her second child birth..had blackish discoloration over the chin region.. had went allopathy treatment and applied cream the discoration dissappeared. after leaving the treatment it comes.. i gave sepia 1m.. no change ..can anybody suggest a remedy
Reportorial rubrics:
[Kent] skin, discoloration, brown, liver spot
[Kent] skin, discoloration, brown, chloasma
[Murphy] skin, chloasma
[Boericke] skin, chloasma, liver spots, moth patches
[Boenninghausen’s] Skin, Spots, Liver (brown, liver-colored, chloasma)
thank for ur reply..@Dr RAVINDRA SARSWAT.. can u suggest remedy for my case

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