Reviews

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Melasma and post-inflammatory hyperpigmentation (PIH)

Keywords | Summary | Correspondence | References


Keywords

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Schlüsselworte

Summary

Melasma is a common hyperpigmentary disorder that commonly affects sun exposed skin, especially the face. It is more common in female, and its exact causes are not well known. Post-inflammatory hyperpigmentation (PIH) can follow tremendous number of inflammatory skin diseases. Various treatment modalities can be used to treat melasma including skin whitening agents, skin peeling, and laser. Chemical whitening agents have been used in dermatology since early sixties of the last century. They can be used to treat melasma and PIH with variable responses, depending on the level of pigmentation. Each hypopigmenting agent has its own mechanism of action. The most famous agent is Hydroquinone (HQ) which, acts by inhibiting tyrosinase enzyme. Other agents include Kojic Acid and Azelic acid with have more or less similar mode of action. Despite their important rules in reducing skin pigmentation these chemicals are not without adverse effects that should be entertained before their uses. As opposed to PIH a good number of patients with melasma will have recurrence after treatment discontinuation. Dermatologist should be familiar with various types of hyperpigmentation and their management.

Zusammenfassung

Das Melasma ist eine häufige Form der Hyperpigmentierung, die im Allgmeinen sonnenexponierte Hautareale, insbesondere des Gesichts, betrifft. Das Melasma ist bei Frauen häufiger anzutreffen. Seine genauen Ursachen sind weitgehend unbekannt. Die postinflammatorische Hyperpigmentierung (PIH) kann auf eine Vielzahl entzündlicher Dermatosen folgen. Für die Behandlung des Melasmas werde verschiedene Modalitäten genutzt: depigmentierende Substanzen, Hautpeeling und Laser. Chemische Pigmentaufheller werden seit den frühen 60er Jahren des letzten Jahrhunderts in der Dermatologie genutzt. Sie könne sowohl beim Melasma als auch bei PIH verwendet werden. Die Ergebnisse sind abhängig vom Grad der Pigmentierung. Die verschiedenen Substanzen haben unterschiedliche Wirkmechanismen. Am bekanntesten dürfte Hydrochinon sein, welches die Tyrosinase hemmt. Andere Substanzen sind Kojic-Säure und Azelainsäure mit einem ähnlichen Wirkmechanismus. Trotz ihrer großen praktischen Bedeutung sind diese Substanzen nicht ohne Nebenwirkungen. Im Gegensatz zur PIH kommt es bei vielen Patienten mit Melasma nach Abschluss der Therapie zu einem Rückfall. Dermatologen sollten mit den unterschiedlichen Typen der Hyperpigmentierung und ihrer Behandlung vertraut sein.


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Address of Correspondence

Prof. Omar M. Alakloby
Professor & Consultant Dermatologist
Dermatopathologist
University of Dammam College of Medicine
P.O. Box 40130, Al-Khobar 31952
Kingdom of Saudi Arabia
oamro@ud.edu.sa

References

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