MELASMA

Supervisor

dr. Asnawi Madjid. Sp. KK. MARS

Advisor dr. Irene Tantia Utami Presenter Ardy Gisnawan, Kintan Ramadhani & Fransisca B. Kuron

Preface
Definition
Melasma is a common hypermelanosis that typically occur on sun exposed area on face.

Characterized

By Brown patches, typically on the malar prominences and forehead

Epidemiology
Age

14-54 years old : = 4 : 1 Asian and Black Skin

Sex

Race or geographic area

Etiology
Idiophatic

Ultraviolet Radiation

Genetetic Predisposit ion

Drugs

EtioPathoge nesis

Pregnancy

Hormonal Cosmetics

Race

Examination

Wood Lamp Examination Histopathology

Diagnoses

Melasma diagnosis examination

Appears:

from

clinical

symmetrical hyperpigmented macules, may form confluent or striped. Lesions: macular light brown or dark brown demarcated with irregular edges.

Count.

Predilection :
Cheeks, upper

lip,

chin,
Forehead

Histophatology

Diagnosis
Anamnesis

Physycal examination

Eliminating other disease

Histopathology

Wood lamp

Differential Diagnoses
1. 2. 3.

4.
5. 6.

7.

Post-inflammatory hyperpigmentation Lentigines Addison disease Drug-induced photosensitivity Lupus erythematosus, discoid Mastocytosis Poikiloderma

Melasma
Etiology Sunshine (UV), hormone, drugs, race (black skin peoples), genetics, cosmetics, idiopathic

PIH
Infection, allergic reactions, mechanical injuries, reactions to medications, phototoxic eruptions, trauma (eg, burns), and inflammatory diseases (eg, lichen planus) any age Depending on the location of infection light brown -black brown macules or patches often with a poorly defined border, irregular in outline and usually with little surface change Asymmetric

Lentigines
History of exposures, Genetic, race (light-skinned ),

Addison Deases
Infection of the adrenal gland

Age

14-54 > Forehead, nose, cheeks, the upper lip, chin Macula (nut brown -deep brown) Macular hyperpigmentation

children and adults; buccal mucosa, gums, hard palate, lips, face, hands and feet Macula (brown -black) Macular hyperpigmentation

The highest prevalence :3050 = Skin and mucous membranes

Predilection

Color of the Lesion Eff.

(blackish brown) Macular hyperpigmentation

Shape of the Lesion Pain in the Lesions Itching of the Lesions Burning Sensation of the Lesion Hyperasthesia

symmetric (irregular) -

Asymmetric (oval / irregular)

Asymmetric

Melasma
Etiology Sunshine (UV), hormonal, drugs, race (heavily pigmented skin), genetics, cosmetics, idiopathic 14-54 > Forehead, nose, cheeks, the upper lip, chin Macula (nutbrown deep brown) Macular hyperpigmentation

DIP
Chemicals photosensitizing, race (heavily pigmented skin)

LED
Trauma : sunshine, chill, wind, friction; race (fair-skinned); descent

Mastocytosis
race (fair-skinned),

Poikiloderma
Sunshine (UV), chemicals photosensitizing, hormonal(low estrogen levels), race (fairskinned), genetics Middle-aged or elderly women Lateral cheek and neck

Age

any age > Face, body, extemity

The highest prevalence : 40-60 > Face, ears, chest, arm, head, back eyes Macula (Reddish blackish brown) Macular erythematous, hyperpigmented macules numular placards (butterfly app.), teleangiektasis , follicular occlusion. symmetric

The highest prevalence :30-49 = Scalp, face, extremity, palms and soles Macula (yellow-tan to red-brown) papules, nodules, and plaques , blisters and bullae

Predilection

Color of the Lesion

Reddish

reddish brown

Eff.

Macular erythematous

Reticulate pigmentation with atrophy and telangiectasia

Shape of the Lesion Pain in the Lesions Itching of the Lesions Burning Sensation of the Lesion Hyperasthesia

symmetric (irregular) -

Asymmetric

Symmetric (regular: circle / oval)

symmetric

Treatment Topical Clinic Therapy

Hydroquinone Tretionin Azelaic Acid Silymarin cream Glycolic acid Chemical Peels Laser Therapy Dermabration Skin Needling

Thank You

Chemical Peeling

Laser Therapy

Dermabration

Skin Needling