Objectives: 1. To list the triggering factors of melasma relapse based on the studies of etiology and pathogenesis of this hypermelanosis
2. To name the cosmeceutical ingredients that trigger/prevent melasma relapse
3. To formulate evidence-based recommendations for successful management of melasma with lower risk of relapse
Introduction: Melasma is a chronic relapsing disease, which commonly affects women with darker skin phototypes. The etiological factors of melasma are: genetic predisposition, UV and blue light exposure, pregnancy, oral contraceptive pill (OCP) intake, diseases of liver and thyroid gland. In the pathogenesis, the progesterone and estrogen, vascular endothelial growth factor, dermal factors, genes TYR, MITF, SILV, TYRP1, play role.
Materials / method: In our study, 115 patients with facial hypermelanoses (melasma and postinflammatory hyperpigmentation) were examined. Methods: Wood’s lamp (Everplus skin analyzer B-601 16W) + dermoscopy (FotoFinder Handyscope 20x). Blood tests: CBC, liver function tests (bilirubin, AST, ALT, alkaline phosphatase, GGT, total blood protein, albumin, globulin), thyroid hormones (TSH, FT3, FT4), reproductive system hormones (FSH, LH, progesterone, prolactin, estradiol, testosterone free and total), ACTH, iron levels in blood serum, vitamins B12 and D levels (vitamin D 25-OH, total).
Results: The study has shown significant biochemical disturbances in patients with melasma, in males and in females, disturbances in sex hormone levels, deficiency and insufficiency of vitamin D in 71 (61,7%) of patients with hypermelanoses, which should be taken into consideration in management, treatment and rehabilitation of such patients. Treatment method with oral cholecalciferol and topical SPF cream and azelaic acid was proposed and has shown significant improvement in 62,2% of melasma cases compared to the group treated with traditional therapy (by MASI, DLQI, dermoscopy, vitamin D-status).
Conclusion: In order to successfully treat patients with melasma and to decrease the rate of relapse, it is important to inform patients that this is chronic relapsing disease, to collect family history of this facial hypermelanosis, to recommend consultation with endocrinologist (blood tests, discontinue OCP intake, compensate the deficiency of vitamin D and hormonal imbalance); to prescribe SPF cream with UVA, UVB and blue light protection, and cosmeceuticals that affect all stages of melanogenesis for more than 6 months; to stop the procedures that stimulate angiogenesis in cases of vascular melasma.
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