Skin hyperpigmentation (Melasma)

Skin hyperpigmentation or melasma is a skin condition characterized by brown coloration of the skin, caused by an abnormal pigment infiltration of the basal layer of the epidermis or dermis.

This condition is due to an abnormal hypersecretion of melanin or its abnormal localization. Skin hyperpigmentation most often results from repeated and prolonged exposure to ultraviolet rays, in the absence of photoprotective measures, after the age of 30-35 years. It can also be the result of metabolic, endocrine, neoplastic and inflammatory diseases, chemical poisoning, treatment with certain drugs, genetic defects, heat burns, ionizing radiation.

Ephelids (freckles) are a form of localized hyperpigmentation, conditioned by sun exposure, which occur especially in people with light skin, especially in childhood, on the face, upper limbs and chest.

A specific form of hyperpigmentation is found in pregnancy. Pregnancy mask or chloasma is manifested by skin hyperpigmentation that mainly affects the perioral region, cheeks and forehead.

A number of inflammatory skin conditions, such as acne, atopic dermatitis or psoriasis, as well as repeated local trauma, may be followed by residual hyperpigmentation, especially on a predisposing genetic background.

Skin hyperpigmentation may be a sign of pathological conditions such as Addison's disease (hypersecretion of glucocorticoids with hyperpigmentation on both sun and unexposed areas), skin porphyria (generalized hyperpigmentation and skin fragility) or scleroderma (hyperpigmental localization).

Diagnosis and treatment of melasma

Wood lamp, determination of electrolytes and serum cortisol, porphyrins and urinary melanin, as well as skin biopsy are the main investigations necessary to detect melanin pigment as well as the underlying cause. The discovery of suspicious pigmented lesions directs the patient to an additional dermatoscopic examination.

After determining the type of pigmentation and the age of the condition, the specialist may recommend peeling of different concentrations, as well as using depigmenting creams (hydroquinone, azelaic acid, kojic acid, glycolic acid, topical retinoids or vitamin C for several months). ). This treatment must be accompanied by proper hydration of the skin and the obligatory application of the cream with SPF 50+.