FREQUENCY OF THYROID DISORDERS IN

PATIENTS PRESENTING WITH MELASMA IN KRL

HOSPITAL ISLAMABAD

Synopsis Submitted By:

DR.MUHAMMAD IRFAN
Trainee Medical Officer
Dermatology Department
KRL Hospital
Islamabad
FREQUENCY OF THROID DISORDERS IN PATIENTS PRESENTING
WITH MELASMA IN KRL HOSPITAL ISLAMABAD
INTRODUCTION:
Melasma is an acquired pigmentary disorder characterized by symmetrical blotchy or splotchy
hyperpigmented macules and patches specifically inflicting the face and rarely forearms. The
term melasma is derived from ‘melas’ a Greek word which means black. It sometimes also
referred as chloasma from the Greek word ‘chloazein’ meaning green due to the appearance of
it in pregnancy however this is taken as a misnomer.1
Melasma (Chloasma) is a commonly acquired disease of the skin. It is a hypermelanosis that
is primarily found on areas of skin with high sun exposure, such as the face and some other sun
exposed areas. It is often seen on the forehead, upper lip, cheeks and chin. Three dominant
types include: centro-facial, mandibular and malar and it is more common in women.2
A variety of factors can influence its onset including sun exposure, drugs, genetic influence
and emotional factors wherein the primary cells involved are the pigment producing
melanocytes that originate from the neural crest and can be influenced by cells in close
proximity (keratinocytes, fibroblasts).3 Melasma affects the quality of life of patients because
it causes emotional distress, affecting the appearance of the person and social problems. As it
mainly affects the exposed parts of the body i.e. face and arms which are easily visible and
difficult to hide.4

Coming to the causes of melasma, they are multi-factorial and not ascertained. The different
causative factors include: oral contraceptives, genetics, U.V. exposure, pregnancy, ethnicity,
cosmetics or it can be idiopathic.5

The relationship between thyroid dysfunctions and skin signs is complex and there are few
studies about it. Both hyper and hypo-thyroidism can have melasma association. Each of them
can cause rashes which may be specific and unspecific. Based upon study, thyroid dysfunctions
are associated with dry skin 56% of the time, telogen effluvium 37.5% of the time, hair loss
40.62% of the time, melasma 18.7% of the time, and vitiligo, alopecia areata, xanthelasma
palpebrarum 22% of the time and rarely pemphigus.6
A study conducted by Aboobacker S in 2017 found out that hypothyroidism was accountable
for considerable portion of melasma and also had a female predisposition. In this study MASI
scores were high in hypothyroid group than euthyroid group and were also significant.7
In another study a total of 70 women with melasma and 70 age-matched healthy women with
no history of melasma were enrolled and thyroid hormone profile was studied in both groups.
Patients with melasma had 18.5% frequency of thyroid disorders, and 15.7% had positive anti-
TPO, while subjects from the control group had a 4.3% frequency of thyroid abnormalities,
and only 5.7% had positive anti-TPO. There was a significantly higher prevalence of thyroid
dysfunction in women with melasma when compared with control group (P = 0.008).8
The rationale of the study is to find out the frequency of thyroid disorders in melasma patients
and the results of which can be used for the future prevention of melasma in patients with
thyroid disorders and at the same time it can also be helpful to increase awareness of this among
medical personnel.

OBJECTIVE:
To determine the frequency of thyroid disorders in patients presenting with melasma in KRL
Hospital Islamabad.

OPERATIONAL DEFINITIONS:
Melasma:Melanosis with sharply demarcated blotchy, brown macules usually in a symmetric
distritution over the cheeks and forehead and sometimes on the upper lip and neck and
diagnosed clinically.
Hypothyroid: T3 values of less than 0.80ng/ml and/or TSH values of more than 4.2ulU/ml
will be considered as hypothyroidism.
Euthyroid: T3 values ranging from 0.80 to 2.0ng/ml and TSH values ranging from 0.27 to
4.2uiU/ml will be considered as euthyroid.
Hyperthyroid: T3 values of more than 2.0ng/ml and/or TSH values of less than 0.27 will be
considered as hyperthyroidism.

MATERIALS AND METHODS:

Study design: Cross sectional study.
Settings: KRL Hospital Islamabad.
Duration of study: Six month after approval of synopsis.
Sample Size: Total sample size will be 234 using WHO software for sample size determination
in health studies.
Confidence level = 95%
Anticipated population proportion = 18.7%6
Absolute precision = 5%
Sample technique: Consecutive non-probability sampling technique.

SAMPLE SELECTION:
Inclusion criteria:
 Patient aged 16 to 60 years
 Both genders
 Patients presenting with melasma of any type
Exclusion criteria:
 Pregnancy
 Age below 16 or above 60 years
 Women having history of melasma during previous pregnancy
 Family History of melasma
 Women taking oral contraceptives
 History of thyroid diseases or autoimmune diseases
 Patients using anti-thyroid agents or thyroid hormone replacement

DATA COLLCETION PROCEDURE:

This study will be conducted after approval from the ethical board and research committee of
Hospital. All patients meeting the inclusion criteria will be included in the study. The purpose
and benefits of study will be explained to the patients and a written informed consent will be
obtained. The patients will be allocated in the study by consecutive non-probability sampling
method after following inclusion and exclusion criteria. A standard history and clinical
examination chart will be completed for each patient included in the study to reach a conclusive
diagnosis. Data will be recorded on proforma regarding demographic variables and also the
information regarding melasma and thyroid status both clinically and with laboratory findings.

DATA ANALYSIS PROCEDURE:

Data will be analyzed using SPSS version 20. Quantitative variables like age will be described
in terms of means + standard deviation. Categorical data like gender, thyroid status, daily
sunlight exposure and medications used will be described in the terms of frequencies and
percentages. Data will be stratified by age and gender and analyzed with respect to outcome
variable. Post stratification chi-square test will be used at 5% significance level. All results will
be presented in the form of tables and figures.
REFERENCES:

1. Miot LD, Miot HA, Silva MG, Marques ME. Physiopathology of melasma. An Bras
Dermatol.2009;84: 623-35.
2. Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzalez EA, Villemur JA, et al.
Association of melasma with thyroid autoimmunity and other thyroidal abnormalities
and their relationship to the origin of the melasma. J Clin Endocrinol
Metab.1985;61(1):28-31
3. Kim JY, Lee TR, Lee AY. Reduced WIF-1 expression stimulates skin
hyperpigmentation in patients with melasma. J Invest Dermatol. 2013;133:191-200.
4. Handel AC, Bartoli LD and Miot HA. Melasma: a clinical and epidemiological review.
An Bras Dermatol. 2014; 89(5):771–82.
5. Kasraee B, Ardekani GH, Parhizgar A, Handjani F, Omrani GR, Samani M, et al. Safety
of topical methimazole for the treatment of melasma. Transdermal absorption, the effect
on thyroid function and cutaneous adverse effects. Skin Pharmacol Physiol.
2008;21(6):300-5.
6. Talaee R, Ghafarpasand I, Masror H. The Relationship Between Melasma and
Disturbances in the Serum Level of Thyroid Hormones and Indices. Medicine Journal.
2015;2(2):19-23.
7. Aboobacker S, Karthikeyan K. Melasma and Hypothyroidism: Conflicting
Coexistence?. J Clin Exp Dermatol.2017;8:429.
8. Mogaddam MR, Alamdari MI, Maleki N, Ardabili NS, Abedkouhi S. et al. Evaluation
of autoimmune thyroid disease in melasma. Journal of Cosmetic
Dermatology.2015;14(2): 167-71.
 FREQUENCY OF HYPOTHYROIDISM IN PATIENTS PRESENTING
WITH MELASMA IN KRL HOSPITAL ISLAMABAD

PROFORMA

Serial No._____________

Date___________________

Name_______________________________________

Father/Husband Name: _______________________

Age__________________

Gender_________________

Address___________________________________________________________________

Hospital No. ____________________________________________________________

Education: Uneducated_____ Matriculate_____ Graduate_____

Residence: Urban_____ Rural_____

Marital Status: Single______ Married______

Occupation: __________________________________

Duration of melasma: ________________________________________

Hormone values: T3_________ T4________ TSH________

Thyroid status: Hypothyroid___ Hyperthyroid___ Euthyroid___

Daily sunlight exposure: Less than 2 hours___ 2-4 hours___ 4-8 hours___

History of medication used: _______________________________________________