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December 1995, Vol 131, No. 12 >
Article | December 1995

Melasma: Title and subTitle BreakEtiologic and Therapeutic Considerations

Pearl E. Grimes, MD
[+] Author Affiliations

From the Division of Dermatology, King-Drew Medical Center, Los Angeles, Calif.


Arch Dermatol. 1995;131(12):1453-1457. doi:10.1001/archderm.1995.01690240119022
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Background:  Melasma is a common acquired symmetric hypermelanosis characterized by irregular light- to gray-brown macules and patches involving sunexposed areas of skin. Etiologic factors in the pathogenesis of melasma include genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, cosmetics, phototoxic drugs, and antiseizure medications.

Observations:  Melasma is often a therapeutically challenging disease, and current treatments include hypopigmenting agents, chemical peels, and lasers. Hypopigmenting agents include phenolic and nonphenolic derivatives. Phenolic agents include hydroquinone and hydroquinone combination preparations. Despite controversies regarding the issue of hydroquinone-induced ochronosis, hydroquinone remains the most effective topically applied bleaching agent approved by the Food and Drug Administration for the treatment of melasma. Nonphenolic bleaching agents include tretinoin and azelaic acid. Superficial, medium, and deep chemical peels are more often used in lighter-complexioned patients. Such peels should be used with caution in blacks. Although lasers have demonstrated significant efficacy in the treatment of a variety of hyperpigmentary disorders, their precise efficacy and place in the therapy of melasma have yet to be established.

Conclusions:  In the hierarchy of therapies for melasma, the treating physician must consider the devastating psychosocial impact of pigmentary imperfections within the realm of the benefits and risks associated with each treatment.(Arch Dermatol. 1995;131:1453-1457)

REFERENCES

1 +
Grimes PE.  Diseases of hyperpigmentation . In: Sams WM, Lunch, PJ, eds. Principles and Practice of Dermatology . New York, NY: Churchill Livingstone Inc; 1990;:807-819.
2 +
Vazquez M, Maldonado H, Benaman C, Sanchez JL.  Melasma in men: a clinical and histologic study . Int J Dermatol. 1988;;27:25-27.
3 +
Pathak MA, Fitzpatrick TB, Kraus EW.  Usefulness of retinoic acid in the treatment of melasma . J Am Acad Dermatol. 1986;;15:894-899.
4 +
Sanchez NP, Pathak MZ, Fitzpatrick TB, Sanchez JL, Mihm MC.  Melasma . J Am Acad Dermatol. 1981;;4:698-710.
5 +
Haider RN, Grimes PE, McLaurin CI, Kress MA, Kennery JA Jr.  Incidence of common dermatoses in a predominantly black dermatologic practice . Cutis. 1983;;32:388-390.
6 +
Perez M, Sanchez JL, Aquilo F.  Encocrinologic profile of patients with idiopathic melasma . J Invest Dermatol. 1983;;81:543-545.
7 +
Lufti RJ, Fridmanis M, Misrunas AL, et al.  Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of melasma . J Clin Endocrinol Metab. 1985;;61:28-31.
8 +
Palumb A, d'Ischia M, Misuraca G, Prota G.  Mechanism of inhibition of melanogensis by hydroquinone . Biochem Biophys Acta. 1991;;1073:85-90.
9 +
Arndt KA, Fitzpatrick TB.  Topical use of hydroquinone as a depigmenting agent . JAMA. 1965;;194:965-967.
10 +
Fitzpatrick TB, Arndt KA, el Mofty AM, Pathak MA.  Hydroquinone and psoralens in the therapy of hypermelanosis and vitiligo . Arch Dermatol. 1966;;93:589-600.
11 +
Sanchez IL, Vazquez M.  A hydroquinone solution in the treatment of melasma . Int J Dermatol. 1982;;21:55-58.
12 +
Glenn M, Grimes PE, Pitt E, Chalet M, Kelley AP.  Evaluation of clinical and light microscopic effects of various concentrations of hydroquinone . Clin Res. 1991;;39:83A. Abstract.
13 +
Kligman AM, Willis I.  A new formula for depigmenting human skin . Arch Dermatol. 1975;;111:40-48.
14 +
Gano SE, Garcia RL.  Topical tretinoin, hydroquinone and betamethasone valerate in the therapy of melasma . Cutis. 1979;;23:239-241.
15 +
Vazquez M, Sanchez IL.  The efficacy of a broad-spectrum sunscreen in the treatment of melasma . Cutis. 1983;;32:92-96.
16 +
Engasser PE, Maibach HI.  Cosmetics and dermatology: bleaching creams . J Am Acad Dermatol. 1981;;5:143-147.
17 +
Grimes PE.  Vitiligo . Dermatol Clin. 1993;;11:325-338.
18 +
Findley GH, Morrison JGL, Simon IW.  Exogenous ochronosis and pigmented colloid milium from hydroquinone bleaching creams . Br J Dermatol. 1975;;93:613-622.
19 +
Jordaan HF, Van Niekerk DJT.  Transepidermal elimination in exogenous ochronosis: a report of two cases . Am J Dermatopathol. 1991;;13:418-424.
20 +
Lawrence N, Bligard CA, Reed R, Perret WJ.  Exogenous ochronosis in the United States . J Am Acad Dermatol. 1988;;18:1207-1211.
21 +
Grimes PE, Stockton T.  Pigmentary disorders in blacks . Dermatol Clin. 1988;; 6:271-281.
22 +
Snider RI, Theirs BH.  Exogenous ochoronosis . J Am Acad Dermatol. 1993;;28: 662-664.
23 +
Bleehen SS.  The treatment of hypermelanosis with 4-isopropylcatechol . Br J Dermatol. 1976;;94:687-694.
24 +
Jimbow K.  N-acetyl-4-S-cysteaminylphenol as a new type of depigmenting agent for the melanoderma of patients with melasma . Arch Dermatol. 1991;;127: 1528-1534.
25 +
Fitton A, Goa KL.  Azelaic acid . Drugs. 1991;;41:780-798.
26 +
Rigoni C, Toffolo P, Serri R, Caputo R.  Impiego di una crema a base di acido azelaico 20% nel trattamento del melasma . G Ital Dermatol Venereol. 1989;;124:1-6.
27 +
Verallo-Rowell VM, Verallo V, Graupe K, Lopez-Villafuerte L, Garcia-Lopez M.  Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma . Acta Derm Venereol Suppl (Stockh) . 1989;;143:58-61.
28 +
Balina LM, Graupe K.  The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream . Int J Dermatol. 1991;;30:893-895.
29 +
Bulengo-Ransby SM, Griffiths CE, Kimbrough-Green CKL, et al.  Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients . N Engl J Med. 1993;;32:1438-1443.
30 +
Griffiths CE, Finkel LT, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ.  Topical tretinoin (retinoic acid) improves melasma: a vehicle-controlled, clinical trial . Br J Dermatol. 1993;;129:415-421.
31 +
Kimbrough-Green CK, Griffiths CE, Finkel LJ, et al.  Topical retinoic acid (tretinoin) for melasma in black patients . Arch Dermatol. 1994;;130:727-733.
32 +
Tadaki T, Watanabe M, Kumasaki K, et al. The effect of topical tretinoin on the photodamaged skin of the Japanese . 1993;;169:131-139.
33 +
Matarasso SL, Glogau RG.  Chemical face peels . Dermatol Clin. 1991;;9:131-150.
34 +
Grimes PE, Gambrell-Hunt S.  Considerations for cosmetic surgery in the black population . Clin Plast Surg. 1993;;20:27-34.
35 +
Moy LS, Murad H, Moy RL.  Glycolic acid peels for the treatment of wrinkles and photoaging . J Dermatol Surg Oncol. 1993;;19:243-240.
36 +
Grekin RC, Shelton RM, Geisse JK, Frieden I. 510-nm pigmented lesion dye laser: its characteristics and clinical uses . J Dermatol Surg Oncol. 1993;;19:380-387.
37 +
Fitzpatrick RE, Goldman MP, Ruiz-Esparza J.  Laser treatment of benign pigmented epidermal lesions using a 300-nsecond pulse and 510-nm wavelength . J Dermatol Surg Oncol. 1993;;18:341-347.
38 +
Dinehart SM, Waner M, Flock S.  The copper vapor laser for treatment of cutaneous vascular and pigmented lesions . J Dermatol Surg. 1993;;19:370-375.
39 +
Goldberg DJ.  Benign pigmented lesions of the skin: treatment with the Q-switched ruby laser . J Dermatol Surg Oncol. 1993;;18:376-379.
40 +
McBurney El.  Clinical usefulness of the argon laser for the 1990s . J Dermatol Surg Oncol. 1993;;19:358-362.
41 +
Taylor CR, Anderson RR.  Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser . J Dermatol Surg Oncol. 1994;;20:592-597.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Grimes PE.  Diseases of hyperpigmentation . In: Sams WM, Lunch, PJ, eds. Principles and Practice of Dermatology . New York, NY: Churchill Livingstone Inc; 1990;:807-819.
2 +
Vazquez M, Maldonado H, Benaman C, Sanchez JL.  Melasma in men: a clinical and histologic study . Int J Dermatol. 1988;;27:25-27.
3 +
Pathak MA, Fitzpatrick TB, Kraus EW.  Usefulness of retinoic acid in the treatment of melasma . J Am Acad Dermatol. 1986;;15:894-899.
4 +
Sanchez NP, Pathak MZ, Fitzpatrick TB, Sanchez JL, Mihm MC.  Melasma . J Am Acad Dermatol. 1981;;4:698-710.
5 +
Haider RN, Grimes PE, McLaurin CI, Kress MA, Kennery JA Jr.  Incidence of common dermatoses in a predominantly black dermatologic practice . Cutis. 1983;;32:388-390.
6 +
Perez M, Sanchez JL, Aquilo F.  Encocrinologic profile of patients with idiopathic melasma . J Invest Dermatol. 1983;;81:543-545.
7 +
Lufti RJ, Fridmanis M, Misrunas AL, et al.  Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of melasma . J Clin Endocrinol Metab. 1985;;61:28-31.
8 +
Palumb A, d'Ischia M, Misuraca G, Prota G.  Mechanism of inhibition of melanogensis by hydroquinone . Biochem Biophys Acta. 1991;;1073:85-90.
9 +
Arndt KA, Fitzpatrick TB.  Topical use of hydroquinone as a depigmenting agent . JAMA. 1965;;194:965-967.
10 +
Fitzpatrick TB, Arndt KA, el Mofty AM, Pathak MA.  Hydroquinone and psoralens in the therapy of hypermelanosis and vitiligo . Arch Dermatol. 1966;;93:589-600.
11 +
Sanchez IL, Vazquez M.  A hydroquinone solution in the treatment of melasma . Int J Dermatol. 1982;;21:55-58.
12 +
Glenn M, Grimes PE, Pitt E, Chalet M, Kelley AP.  Evaluation of clinical and light microscopic effects of various concentrations of hydroquinone . Clin Res. 1991;;39:83A. Abstract.
13 +
Kligman AM, Willis I.  A new formula for depigmenting human skin . Arch Dermatol. 1975;;111:40-48.
14 +
Gano SE, Garcia RL.  Topical tretinoin, hydroquinone and betamethasone valerate in the therapy of melasma . Cutis. 1979;;23:239-241.
15 +
Vazquez M, Sanchez IL.  The efficacy of a broad-spectrum sunscreen in the treatment of melasma . Cutis. 1983;;32:92-96.
16 +
Engasser PE, Maibach HI.  Cosmetics and dermatology: bleaching creams . J Am Acad Dermatol. 1981;;5:143-147.
17 +
Grimes PE.  Vitiligo . Dermatol Clin. 1993;;11:325-338.
18 +
Findley GH, Morrison JGL, Simon IW.  Exogenous ochronosis and pigmented colloid milium from hydroquinone bleaching creams . Br J Dermatol. 1975;;93:613-622.
19 +
Jordaan HF, Van Niekerk DJT.  Transepidermal elimination in exogenous ochronosis: a report of two cases . Am J Dermatopathol. 1991;;13:418-424.
20 +
Lawrence N, Bligard CA, Reed R, Perret WJ.  Exogenous ochronosis in the United States . J Am Acad Dermatol. 1988;;18:1207-1211.
21 +
Grimes PE, Stockton T.  Pigmentary disorders in blacks . Dermatol Clin. 1988;; 6:271-281.
22 +
Snider RI, Theirs BH.  Exogenous ochoronosis . J Am Acad Dermatol. 1993;;28: 662-664.
23 +
Bleehen SS.  The treatment of hypermelanosis with 4-isopropylcatechol . Br J Dermatol. 1976;;94:687-694.
24 +
Jimbow K.  N-acetyl-4-S-cysteaminylphenol as a new type of depigmenting agent for the melanoderma of patients with melasma . Arch Dermatol. 1991;;127: 1528-1534.
25 +
Fitton A, Goa KL.  Azelaic acid . Drugs. 1991;;41:780-798.
26 +
Rigoni C, Toffolo P, Serri R, Caputo R.  Impiego di una crema a base di acido azelaico 20% nel trattamento del melasma . G Ital Dermatol Venereol. 1989;;124:1-6.
27 +
Verallo-Rowell VM, Verallo V, Graupe K, Lopez-Villafuerte L, Garcia-Lopez M.  Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma . Acta Derm Venereol Suppl (Stockh) . 1989;;143:58-61.
28 +
Balina LM, Graupe K.  The treatment of melasma 20% azelaic acid versus 4% hydroquinone cream . Int J Dermatol. 1991;;30:893-895.
29 +
Bulengo-Ransby SM, Griffiths CE, Kimbrough-Green CKL, et al.  Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients . N Engl J Med. 1993;;32:1438-1443.
30 +
Griffiths CE, Finkel LT, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ.  Topical tretinoin (retinoic acid) improves melasma: a vehicle-controlled, clinical trial . Br J Dermatol. 1993;;129:415-421.
31 +
Kimbrough-Green CK, Griffiths CE, Finkel LJ, et al.  Topical retinoic acid (tretinoin) for melasma in black patients . Arch Dermatol. 1994;;130:727-733.
32 +
Tadaki T, Watanabe M, Kumasaki K, et al. The effect of topical tretinoin on the photodamaged skin of the Japanese . 1993;;169:131-139.
33 +
Matarasso SL, Glogau RG.  Chemical face peels . Dermatol Clin. 1991;;9:131-150.
34 +
Grimes PE, Gambrell-Hunt S.  Considerations for cosmetic surgery in the black population . Clin Plast Surg. 1993;;20:27-34.
35 +
Moy LS, Murad H, Moy RL.  Glycolic acid peels for the treatment of wrinkles and photoaging . J Dermatol Surg Oncol. 1993;;19:243-240.
36 +
Grekin RC, Shelton RM, Geisse JK, Frieden I. 510-nm pigmented lesion dye laser: its characteristics and clinical uses . J Dermatol Surg Oncol. 1993;;19:380-387.
37 +
Fitzpatrick RE, Goldman MP, Ruiz-Esparza J.  Laser treatment of benign pigmented epidermal lesions using a 300-nsecond pulse and 510-nm wavelength . J Dermatol Surg Oncol. 1993;;18:341-347.
38 +
Dinehart SM, Waner M, Flock S.  The copper vapor laser for treatment of cutaneous vascular and pigmented lesions . J Dermatol Surg. 1993;;19:370-375.
39 +
Goldberg DJ.  Benign pigmented lesions of the skin: treatment with the Q-switched ruby laser . J Dermatol Surg Oncol. 1993;;18:376-379.
40 +
McBurney El.  Clinical usefulness of the argon laser for the 1990s . J Dermatol Surg Oncol. 1993;;19:358-362.
41 +
Taylor CR, Anderson RR.  Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser . J Dermatol Surg Oncol. 1994;;20:592-597.

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