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Definition

Melasma is a very common patchy brown, tan, or blue-grey skin discoloration, especially on face, hands, chest, and neck, generally seen in women in the reproductive years, primarily related to external sun exposure, external hormones like birth control pills, and internal hormonal changes as seen during pregnancy. (Psora)

When Melasma occurs during pregnancy, it is also called chloasma, or "the mask of pregnancy."

Causes

The precise cause of Melasma is still unknown. It could be activated by several factors-

• Uncontrolled sunlight exposure (Causa occasionalis)
• Pregnancy (Causa occasionalis / Psora)
• Birth control pills (Causa occasionalis)
• Hormone replacement therapy (progesterone)
• Family history of Melasma (Psora / Syphilis)
• Race (Psora / Syphilis)
• Ant seizure medications (Causa occasionalis)
• Medications that make the skin more prone to pigmentation after exposure to Ultraviolet light. (Causa occasionalis)

Pathogenesis

Pregnant women have increased oestrogen, progesterone, and melanocyte-stimulating hormone levels during the second and third trimesters of pregnancy (Psora / Sycosis). Pregnancy-related Melasma may be caused by the presence of increased levels of progesterone and not due to oestrogen and MSH (Psora). Postmenopausal women receiving progesterone replacement therapy are more likely to develop Melasma; while postmenopausal women receiving oestrogen alone seem less likely to develop it. (Causa occasionalis)

Products or treatments that irritate the skin may cause an increase in melanin production and accelerate Melasma symptoms.

People with a genetic predisposition or known family history of Melasma are at an increased risk of developing Melasma. (Psora / Syphilis)

Clinical Presentation of Melasma

The patches are usually quite sharply demarcated, characterized by discoloration or hyperpigmentation primarily on the face. Three types of common facial patterns have been identified-

1. Centrofacial - the most prevalent form of Melasma and includes the forehead, cheeks, upper lip, nose, and chin.
2. Malar - includes the upper cheeks.
3. Mandibular - specific to the jaw.

The upper sides of the neck may less commonly be involved in Melasma. Rarely, Melasma may occur on other body parts like the forearms.

Types

Four types of pigmentation patterns are diagnosed in melisma-

1. Epidermal- identified by the presence of excess melanin in the superficial layers of skin.
2. Dermal- distinguished by the presence of melanophages through out the dermis.
3. Mixed- includes both the epidermal and dermal type.
4. The unnamed type- found in dark-complexioned individuals, in who excess number of melanocytes is present.

Diagnosis

• Melasma is usually easily diagnosed by the typical appearance of brown skin patches on the face.
• Black light or Wood's light (340-400 nm).
• Skin biopsy.

Treatment

Melasma may disappear naturally without any treatment. Sunscreen usage and sun light prevention are good techniques. Melasma may disappear following pregnancy or if birth control pills and hormone therapy are discontinued.

Homoeopathy Remedies For Melasma

Acetan. acon. aeth. agar. ail. am-c. anac. Ant-c. Ant-t. Apis arg-met. Arg-n. arn. ARS. ars-h. ars-i. ars-s-f. asaf. Aur. aur-ar. bac. bad. Bapt. bell. benz-ac. berb. bond. borx. both. Bry. bufo cadm-s. calc. Calc-p. calc-s. calc-sil. camph. cann-xyz. canth. carb-ac. carb-an. Carbn-s. Carb-v. Carc. card-m. CAUL. caust. chel.  chlol. chlorpr. cic. cob. coch. Con. cop. cor-r. Crot-h. CUR. cycl. dig. dros. Dulc. elaps Ferr. ferr-ar. Ferr-i. ferr-pic. gels. glon. graph. guar. Hell. hin. Hyos. Iod. kali-ar. kali-bi. kali-br. kali-c. kali-m. kali-p. kali-s. kali-sil. kreos. lac-e. LACH. lat-m. Laur. led. lil-t. loxo-recl. LYC. lycps-v. mag-c. mag-m. manc. med. MERC. Merc-c. merc-i-r. Mez. moni. morb. musa nat-ar. Nat-c. Nat-hp. nat-hsulo. Nat-m. nat-p. NIT-AC. nux-m. Nux-v. Op. ox-ac. ozone paull. Petr. ph-ac. Phos. phyt. pitu-p. PLB. psor. PSOR. puls. raph. rat. Rhus-t. rob. ruta sabad. sabin.sanic. sars. scarl. SEC. SEP. sil. sol-t-ae. spig. squil. stann. staph. stram. Sul-ac. sul-i. SULPH. sumb. syph. tab. tarent. Thuj. trios. Tub. tub-m. tub-r. verat. Verat-v. Vip. zinc.

Repertory of Melasma

BACK - DISCOLORATION - brown - Cervical region - greasy; skin brown and apis Lyc. Petr. sep. thuj.

EYE – MELANOSIS Aur.

FACE - CHLOASMA - pregnancy agg.; during caul. Con. ferr. nit-ac. SEP.

FACE - CHLOASMA - sun and wind agg.; exposure to cadm-s.

FACE – CHLOASMA ant-c. Ars. cadm-s. card-m. caul. coch. guar. kali-p. lyc. merc-i-r. nux-v. plb. raph. rob. sep. sul-ac. Sulph. syph.

SKIN - DISCOLORATION - blackish – pores sabin.

SKIN - DISCOLORATION - blackish - spots – gray loxo-recl.

SKIN - DISCOLORATION - blackish – spots aeth. anac. arn. Ars. both. cic. Crot-h. ferr. Lach. phos. rhus-t. sars. sec. Vip.

SKIN - DISCOLORATION – blackish acon. ant-c. ant-t. Apis Arg-n. arn. ARS. asaf. aur. bapt. both. carb-ac. Carb-v. chel.  hin. Crot-h. cycl. elaps ferr. gels. hell. kreos. lac-e. Lach. mag-m. merc-c. Merc. nit-ac. nux-v. op. ph-ac. phos. phyt. PLB. SEC. sol-t-ae. spig. staph. stram. sul-ac. verat.

SKIN - DISCOLORATION – bronzed tub.

SKIN - DISCOLORATION - brown - coffee with milk carc.

SKIN - DISCOLORATION - brown - dark brown ars-h.

SKIN - DISCOLORATION - brown – elevated caust.

SKIN - DISCOLORATION - brown – inflamed ferr.

SKIN - DISCOLORATION - brown – itching caust. lyc. sulph.

SKIN - DISCOLORATION - brown - liver spots am-c. Ant-c. ant-t. Arg-n. arn. ars-i. ars-s-f. Ars. aur-ar. Aur. bad. borx. bry. cadm-s. calc-p. calc-s. calc-sil. calc. canth. Carb-v. Carbn-s. carc. caul. caust. chel. Con. cop. cor-r. crot-h. CUR. dros. Dulc. ferr-ar. ferr-i. ferr. graph. Hyos. Iod. kali-ar. kali-bi. kali-c. kali-p. kali-s. kali-sil. LACH. Laur. led. LYC. Merc-c. merc-i-r. MERC. Mez. moni. musa nat-ar. Nat-c. nat-hsulo. nat-m. nat-p. NIT-AC. Nux-v. ozone petr. Phos. Plb. psor. puls. ruta sabad. SEP. sil. stann. sul-ac. sul-i. SULPH. tarent. Thuj. trios. Tub.

SKIN - DISCOLORATION - brown - spots - coffee with milk carc.

SKIN - DISCOLORATION - brown - spots - eruptions; after berb.

SKIN - DISCOLORATION - brown – spots bac. carc. card-m. con. crot-h. iod. lach. lyc. merc. petr. phos. sanic. sep. sulph. thuj.

SKIN - DISCOLORATION - brown – suppurating ferr.

SKIN - DISCOLORATION – brown ant-c. arg-n. Ars. aur. bapt. berb. borx. Bry. calc-p. cann-xyz. carb-v. carc. chel. crot-h. dulc. hyos. iod. kreos. Lach. lyc. lycps-v. manc. nat-m. nit-ac. op. petr. phos. plb. Rhus-t. sec. SEP. staph. Sulph. thuj. verat.

SKIN - DISCOLORATION – chloasma Arg-n. aur. cadm-s. card-m. CAUL. cob. cur. guar. laur. LYC. Nat-hp. nux-v. paull. petr. plb. raph. rob. SEP. sulph. thuj.

SKIN - DISCOLORATION - coppery – spots benz-ac. lach. med. nit-ac.

SKIN - DISCOLORATION – coppery carb-an. cor-r. merc. mez. nit-ac. Rhus-t. syph.

SKIN - DISCOLORATION – dark calc-p.

SKIN - DISCOLORATION – darkening pitu-p.

SKIN - DISCOLORATION - dirty – gray Iod.

SKIN - DISCOLORATION - dirty – spots berb. sabin. Sec.

SKIN - DISCOLORATION – dirty ars. borx. bry. bufo caust. Ferr-i. ferr-pic. Ferr. Iod. kali-ar. merc. Nat-m. Nit-ac. petr. phos. Plb. PSOR. sec. stram. SULPH. tarent. Thuj. tub.

SKIN - DISCOLORATION – dusky ail. Ant-t. arg-n. ars-i. ars. Bapt. Calc-p. camph. carb-v. crot-h. gels. Hell. kali-p. lach. merc. Nit-ac. Nux-v. Op. sec. verat.

SKIN - DISCOLORATION - gray – spots iod. nit-ac.

SKIN - DISCOLORATION – gray Acetan. arg-met. dig. kreos. lach. laur. merc. phos. plb. scarl. sec. tab. tub-m. tub-r. zinc.

SKIN - DISCOLORATION - mottled - chill; during arn. crot-h. kali-br. Nux-v. rhus-t.

SKIN - DISCOLORATION - mottled - washing; after kali-c.

SKIN - DISCOLORATION – mottled ail. am-c. arn. ars. bapt. bell. bond. Carb-v. chlol. cic. con. cop. Crot-h. glon. kali-bi. kali-m. LACH. led. lil-t. loxo-recl. manc. nat-m. nux-m. Nux-v. ox-ac. phos. puls. rhus-t. sars. sulph. syph. thuj. Verat-v.

SKIN - DISCOLORATION - spots – lenticular calc. rhus-t. vip.

SKIN - DISCOLORATION - spots - periodical - year; every Crot-h.

SKIN - DISCOLORATION - spots – small ant-t. bry. lach. led. lyc. merc. op. rat. squil. Sul-ac. vip.

SKIN - DISCOLORATION - spots – smooth carb-an. carb-v. cor-r. lach. mag-c. petr. sumb.

SKIN - DISCOLORATION - spots - star shaped stram.

SKIN - DISCOLORATION – spots agar. Carc. crot-h. dulc. lat-m. morb. thuj.

SKIN - DISCOLORATION - yellow - pregnancy agg.; during acon. aur. phos.

SKIN – MELANOSIS chlorpr.

References

• Chapter 190. Melasma The Color Atlas of Family Medicine
• Melasma Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology > Section 13. Pigmentary Disorders
• Treatment Dermatology > Chapter 152. Diabetes Mellitus and Other Endocrine Diseases > Estrogen and Progesterone
• Melasma and Drug-Induced and Post-Inflammatory Hyperpigmentation Dermatology > Chapter 240. Lasers and Flashlamps in Dermatology > Clinical Applications > Treatment of Pigmented Lesions
• Melasma Dermatology > Chapter 73. Hypomelanoses and Hypermelanoses > Hypermelanosis > Acquired Diffuse Non-Figured Hypermelanosis > Endocrinopathies
• Chloasma CURRENT Diagnosis & Treatment: Obstetrics & Gynecology > Chapter 9. Normal Pregnancy & Prenatal Care > Normal Pregnancy > Diagnosis > Presumptive Manifestations > Signs > Skin
• The disorders in this category are nevoid and congenital or acquired, and include... CURRENT Medical Dx & Tx > Chapter 6. Dermatologic Disorders > Miscellaneous Dermatologic Disorders* > Pigmentary Disorders > Classification > Primary Pigmentary Disorders > Hyperpigmentation
• Figure 107-2 Melasma. Blotchy, mottled hyperpigmentation is evident on the malar cheek and... Dermatology > Chapter 107. Skin Changes and Diseases in Pregnancy > Cutaneous Changes Commonly Associated with Pregnancy
• Figure 152-17 Melasma is demonstrated in a symmetric pattern on the face of a young woman. The... Dermatology > Chapter 152. Diabetes Mellitus and Other Endocrine Diseases > Estrogen and Progesterone > Clinical Findings and Diagnosis: Cutaneous Manifestations of Estrogen Excess and Deficiency
• Melanocytic lesions, including pre-existing nevi and malignant melanoma, can darken during... Dermatology > Chapter 152. Diabetes Mellitus and Other Endocrine Diseases > Estrogen and Progesterone > Clinical Findings and Diagnosis: Cutaneous Manifestations of Estrogen Excess and Deficiency
• Hyperpigmentation is evident beginning early in pregnancy and is more pronounced in naturally... Williams Obstetrics, 23e > Chapter 56. Dermatological Disorders > Skin Changes in Pregnancy > Pigmentation
• Radar 10
• Encyclopedia Homoeopathica 

Melasma and Homoeopathy