Übersichtsarbeit
M. Alakloby, Omar, M. Budair, Fatimah
Melasma und postinflammatorische Hyperpigmentierung (PIH)
Melasma and Post-Inflammatory Hyperpigmentation (PIH)
Keywords | Summary | Correspondence | Literature
Keywords
laser, melasma, peels, post-inflammatory hyperpigmentation, skin whitener
Schlüsselworte
Laser, Melasma, Peels, Pigmentaufheller, postinflammatorische Hyperpigmentierung
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.
Leider haben Sie sich nicht eingeloggt, um den Beitrag lesen zu können. Bitte loggen Sie sich ein oder beantragen Sie Ihre Zugangsberechtigung. Vielen Dank. Weitere Informationen finden Sie hier>
Korrespondenz-Adresse
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
Literatur
References 1. Patient UK web site. Chloasma. Available from http://www. patient.co.uk/ showdoc/40002152/. Accessed November 8, 2009. 2. Werlinger KD, Guevara IL, Gonzalez CM, Rincon ET, Caetano R, Haley RW, et al. (2007) Prevalence of self-diagnosed melasma among pre-menopausal Latino women in Dallas and Forth Worth, Tex. Arch Dermatol 143: 424-5. 3. Pichardo R, Vallejos Q, Feldman SR, Schulz MR, Verma A, Quandt SA, Arcury TA (2009) The prevalence of melasma and its association with quality of life in adult male Latino migrant workers. Intl J of Dermatol 48: 22-6. 4. Failmezger C (1992) Incidence of skin disease in Cuzco, Peru. Int J Dermatol 31: 560-1. 5. Sivayathron A (1995) Melasma in Orientals. Clin Drug Invest 10 (Suppl 2):34-40. 6. El-Assawi D, Musial JL, Hammad A, Lim HW (2007) A survey of skin disease and skin-related issues in Arab-Americans. J Am Acad Dermatol 56: 933-8. 7. Parthasaradhi A, Al Gufai AF (1998) The pattern of skin disease in Hail region, Saudi Arabia. Ann Saudi Med 18: 558-61. 8. Sarkar R, Jain RK, Puri P (2003) Melasma in Indian males. Dermatol Surg 29: 204. 9. Jang YH, Sim HH, Kang HJ, Kim JC, Lee E-O (2012) The histopathological characteristics of male melasma: Comparison with female melasma and lentigo. JAAD 66: 642–9. 10. Taylor S, Grimes P, Lim J, Im S, Lui H (2009) Postinflammatory hyperpigmentation. J Cutan Med Surg 13: 183-91. 11. Davis EC, Callender VD (2010) A review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol 3: 20–31. 12. Tomita Y, Maeda K, Tagami H (1992) Melanocyte-stimulating properties of arachidonic acid metabolites: possible role in postinflammatory pigmentation. Pigment Cell Res 5 (5 Pt 2): 357-61. 13. Chang MW (2009) Disorders of hyperpigmentation. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 2nd ed. Elsevier Mosby pp. 333–89. 14. Sanchez NP, Pathak MA, Sato S (1981) Melasma: a clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol 4: 698-709. 15. Mandry-Pagan RM, Sanchez JL (2000) Mandibular melasma. P R Health Sci J 19: 231-4. 16. Gilchrest BA, Fitzpatrick TB, Anderson RR, Parrish JA (1977) Localization of malanin pigmentation in the skin with Wood‘s lamp. Br J Dermatol 96: 245-8. 17. Kang WH, Yoon KH, Lee ES, et al. (2002) Melasma: histopathological characteristics in 56 Korean patients. Br J Dermatol 146: 228–37. 18. Picardo M, Cardinali G (2011) The genetic determination of skin pigmentation: KITLG and the KITLG/c-Kit pathway as key players in the onset of human familial pigmentary diseases. J Invest Dermatol 131: 1182–5. 19. Kang HY, Hwang JS, Lee JY, Ahn JH, et al. (2006) The dermal stem cell factor and c-kit are overexpressed in melasma. Br J Dermatol 154: 1094-9. 20. Im S, Kim J, On WY, Kang WH (2007) Increased expression of a-melanocyte- stimulating hormone in the lesional skin of melasma. Br J Dermatol 146: 165-7. 21. Mahmoud BH, Ruvolo E, Hexsel CL, Liu Y, Owen MR, Kollias N et al. (2010) Impact of long-wavelength UVA and visible light on melanocompetent skin. J Invest Dermatol 130: 2092–7. 22. Ortonne JP, Arellano I, Berneburg M, et al. (2009) A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol 23: 1254-62. 23. Kang HY, Suzuki I, Lee DJ, Ha J, et al. (2011) Transcriptional profiling shows altered expression of Wnt pathway– and lipid metabolism–related genes as well as melanogenesis-related genes in melasma. J Investig Dermatol 131: 1692–1700. 24. Guevara IL, Pandya AG (2003) Safety and efficacy of 4 % hydroquinone combined with 10 % glycolic acid, antioxidants, and sunscreen in the treatment of melasma. Int J Dermatol 42: 966 – 72. 25. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, et al. (2009) A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol 23: 1254-62. 26. Kippenberger S, Loitsch S, Solano F, Bernd A, Kaufmann R (1998) Quantification of tyrosinase, TRP-1, and Trp-2 transcripts in human melanocytes by reverse transcriptase-competitive multiplex PCR-regulation by steroid hormones. J Invest Dermatol 110: 364–7. 27. Schmidt AN, Nanney LB, Boyd AS, King Jr LE, Ellis DL (2006) Oestrogen receptor-ß expression in melanocytic lesions. Exp Dermatology 15: 971–80. 28. Jang YH (2010) Oestrogen and progesterone receptor expression in melasma: an immunohistochemical analysis. J Eur Acad Dermatol Venereol 24: 1312–6. 29. Adalatkhah H, Amani F (2007) The correlation between melasma, ovarian cysts and androgenic hormones (a case control study). Res J Biol Sci 2: 593–6. 30. Yazdanfar A, Hashemi B (2010) Association of melasma with thyroid autoimmunity: A case-control study. Iran J Dermatol 13: 51–3. 31. Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, et al. (1985) Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab 61: 28–31. 32. Perez M, Sanchez JL, Aguilo F (1983) Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol 81: 543–5. 33. Mahmood K, Nadeem M, Aman S, Hameed A, Kazmi AH (2011) Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females. J Pak Ass Dermatol 21: 241–7. 34. Jo HY, Kim CK, Suh IB et al. (2009) Co-localization of inducible nitric oxide synthase and phosphorylated Akt in the lesional skin of patients with melasma. J Dermatol 36: 10–16. 35. Kim EH, Kim YC, Lee ES, Kang HY (2007) The vascular characteristics of melasma. J Dermatol Sci 46: 111–6. 36. Kang HY, Bahadoran P, Suzuki I, Zugaj D, Khemis A, Passeron T et al. (2010) In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution. Exp Dermatol 19: e228–33. 37. Passeron T, Fontas E, Kang HY, Bahadoran P, Lacour JP, Ortonne JP (2011) Melasma treatment with pulsed-dye laser and triple combination cream: a prospective, randomized, single-blind, split-face study. Arch Dermatol 147: 1106–8. 38. Sturm RA, Duffy DL, Box NF, Chen W, Smit DJ, Brown DL (2003) The role of melanocortin-1 receptor polymorphism in skin cancer phenotypes. Pigment Cell Res 163: 266–72. 39. Arvjot V, Sharma S, Mishra S, Singh A (2009) Melasma: a clinicopathological study of 43 cases. Indian J Pathol Microbiol 52: 357–9. 40. Lawrence N, Cox SE, Brody HJ (1997) Treatment of melasma with Jessner‘s solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood‘s light examination. J Am Acad Dermatol 36: 589–93. 41. Piamphongsant T (1998) Treatment of melasma: a review with personal experience. Int J Dermatol 37: 897–903. 42. Palumbo A, d‘Ischia M, Misuraca G, Prota G (1991) Mechanism of inhibition of melanogenesis by hydroquinone. Biochem Biophys Acta 1073: 85–90. 43. Gupta AK, Gover MD, Nouri K, Taylor S (2006) The treatment of melasma: A review of clinical trials. J Am Acad of Dermatol 55: 1048–65. 44. Amer M, Metwalli M (1998) Topical hydroquinone in the treatment of some hyperpigmentary disorders. Int J Dermatol 37: 449–50. 45. Haddad AL, Matos LF, Brunstein F, Ferreira LM, Silva A, Costa D Jr. (2003) A clinical, prospective, randomized, double-blind trial comparing skin whitening complex with hydroquinone vs placebo in the treatment of melasma. Int J Dermatol 42: 153–6. 46. Bentley-Phillips B, Bayles MA (1975) Cutaneous reactions to topical application of hydroquinone: results of a 6-year investigation. S Afr Med J 49: 1391–5. 47. Badreshia-Bansal S, Draelos ZD (2007) Review Insight into skin lightening cosmeceuticals for women of color. J Drugs Dermatol 6: 32–9. 48. Levin CY, Maibach H. Exogenous ochronosis (2001) An update on clinical features, causative agents and treatment options. Am J Clin Dermatol 2: 213–7. 49. Hoshaw RA, Zimmerman KG, Menter A (1985) Ochronosis like pigmentation from hydroquinone bleaching creams in American blacks. Arch Dermatol. 121: 105–8. 50. Lynde CB, Kraft JN, Lynde CW (2006) Topical treatments for melasma and postinflammatory hyperpigmentation. Skin Therapy Lett 11: 1–6. 51. Griffiths CE, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ (1993) Topical tretinoin (retinoic acid) improves melasma: a vehiclecontrolled, clinical trial. Br J Dermatol 129: 415–21. 52. Kligman AM, Willis I (1975) A new formula for depigmenting human skin. Arch Dermatol 111: 40–48. 53. Kanwar AJ, Dhar S, Kaur S (1994) Treatment of melasma with potent topical corticosteroids. Dermatology 188: 170. 54. Gano SE, Garcia RL (1979) Topical tretinoin, hydroquinone, and betamethasone valerate in the therapy of melasma. Cutis 23: 239–41. 55. Chan R, Park KC, Lee MH, Lee ES (2008) A randomized controlled trial of the efficacy and safety of a fixed triple combination (fluocinolone acetonide 0.01 %, hydroquinone 4 %, tretinoin 0.05 %) compared with hydroquinone 4 % cream in Asian patients with moderate to severe melasma. Br J Dermatol 159: 697–703. 56. Gupta AK, Gover MD, Nouri K, Taylor S (2006) The treatment of melasma: A review of clinical trials. J Am Acad Dermatol 55: 1048–65. 57. Verallo-Rowell VM, Verallo V, Graupe K et al. (1989) Double-blind comparison of azelaic acid and hydroquinone in the treatment of melasma. Acta Derm Venereol (Stockh) 143 (Suppl): 58–61. 58. Kakita LS, Lowe NJ (1998) Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone. Clin Ther 20: 960–70. 59. Ortonne JP, Passeron T (2005) Melanin pigmentary disorders: treatment update. Dermatol Clin 23: 209–26. 60. Garcia A, Fulton JE Jr. (1996) The combination of glycolic acid and hydroquinone or Kojic acid for the treatment of melasma and related conditions. Dermatol Surg 22: 443–7. 61. Lim JT (1999) Treatment of melasma using Kojic acid in a gel containing hydroquinone and glycolic acid. Dermatol Surg 25: 282–4. 62. Malaloto RM, Alster T (1999) Erbium-YAG laser resurfacing for refractory melasma. Dermatol Surg 25: 121–3. 63. Nouri K, Bowes L, Chartier T, Romagosa R, Spencer J (1999) Combination treatment of melasma with pulsed CO 2 laser followed by Q-switched alexandrite laser: A pilot study. Dermatol Surg 25: 494–497. 64. Taylor CR, Anderson RR (1994) Ineffective treatment of refractory melasma and postinflammatory hyperpigmentation by Q-switched ruby laser. J Dermatol Surg Oncol 20: 592–7. 65. Tannous ZS, Astner S (2005) Utilizing fractional resurfacing in the treatment of therapy-resistant melasma. J Cosmet Laser Ther 7: 39–43. 66. Neeley MR, Pearce Jr FB, Collawn SS (2010) Successful treatment of malar dermal melasma with a fractional ablative CO 2 laser in a patient with type V skin. J Cosmet Laser Ther 12: 258–60. 67. Jeong SY, Chang SE, Bak H, Choi JH, Kim IH (2008) New melasma treatment by collimated low fluence Q-switched Nd:YAG laser. Korean J Dermatol 46: 1163–70. 68. Kim MJ, Kim JS, Cho SB (2009) Punctate leucoderma after melasma treatment using 1064-nm Q-switched Nd:YAG laser with low pulse energy. J Eur Acad Dermatol Venereol 23: 960–2. 69. Li YH, Chen JZS (2008) Efficacy and safety of intense pulsed light in treatment of melasma in Chinese patients. Dermatol Surg 34: 693–701. 70. Grimes PE, Gombrell-Hunt S (1993) Considerations for cosmetic surgery in the black population. Clin Plast Surg 20: 27–34. 71. Slavin JW (1998) Consideration in alpha hydroxy acid peels. Clin Plast Surg 25: 45–52. 72. Gupta RR, Mahajan BB, Garg G (2001) Chemical peeling—evaluation of glycolic acid in varying concentrations and time intervals. Cosmetology 67: 28-9. 73. Sarkar R, Kaur C, Bhalla M, Kanwar AJ (2002) The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients: a comparative study. Dermatol Surg 28: 828–32. 74. Erbil H, Sezer E, Tastan B, Arca E, Kurumlu Z (2007) Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma. J Dermatol 34: 25–30. 75. Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA (2005) Lactic acid as a new therapeutic peeling agent in melasma. Dermatol Surg 31: 149–54. 76. Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA (2006) Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner‘s solution chemical peels. Dermatol Surg 32: 1429–36. 77. Taylor S, Grimes P, Lim J, Im S, Lui H (2009) Postinflammatory hyperpigmentation. J Cutan Med Surg 13: 183–91. 78. Wolff K, Johnson RA, Szuurmond D (2005) Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. Toronto: McGraw-Hill. 79. Bolognia JL, Jorizzo JL, Rapini RP (2003) Dermatology. Toronto: Mosby. 80. Rendon M, Berneburg M, Arellano I, Picardo M (2006) Treatment of melasma. J Am Acad Dermatol 54 (5 Suppl): S272–81. 81. Taylor SC, Torok H, Jones T, et al. (2003) Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis 72: 67–72. 82. Garcia A, Fulton JE Jr. (1996) The combination of glycolic acid and hydroquinone or Kojic acid for the treatment of melasma and related conditions. Dermatol Surg 22: 443–7. 83. Burns RL, Prevost-Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP (1997) Glycolic acid peels for postinflammatory hyperpigmentation in black patients: A comparative study. Dermatol Surg 23: 171–4.