Übersichtsarbeit
Carmen Salavastru, Klaus Fritz
Melasma: Diagnose und Therapie – Ein Update
Melasma: Diagnosis and therapy – an update
Keywords | Summary | Correspondence | Literature
Keywords
chemical peelings, Chloasma, laser therapy, melasma
Schlüsselworte
chemische Peelings, Chloasma, Lasertherapie, Melasma
Summary
Hyperpigmentation or chloasma or melasma generally refers to excessive storage of melanin in the skin. Parts of the skin esp. the face can be affected. Various factors interact in the development of melasma. Certain physical messenger substances, such as MSH and ACTH, as well as the female hormones estrogen and progesterone, have a particularly strong influence. During pregnancy and lactation, a particularly large number of hormonal changes occur in the female body. Up to 70% of all pregnant women are affected by melasma. This article gives an overview of the diagnostics as well as the current treatment options. The spectrum ranges from systemic and topical therapy to peelings and laser therapy.
Zusammenfassung
Hyperpigmentierung oder Chloasma oder Melasma bezeichnet allgemein eine übermäßig starke Einlagerung von Melanin in die Haut. Betroffen sein können Teile der Haut insbesondere des Gesichts. Bei der Entstehung von Melasmen wirken verschiedene Faktoren zusammen. Einen besonders großen Einfluss haben bestimmte körperliche Botenstoffe wie beispielsweise MSH und ACTH sowie die weiblichen Hormone Östrogen und Progesteron, besonders während der Schwangerschaft und Stillzeit. Bis zu 70% aller schwangeren Frauen sind von Melasmen betroffen. Dieser Artikel gibt einen Überblick der Diagnostik sowie der aktuellen Behandlungsmöglichkeiten. Die Bandbreite reicht von systemischer-, topischer Therapie über Peelings bis zur Lasertherapie.
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Korrespondenz-Adresse
Prof. assoc. Dr. med. Klaus Fritz
Reduitstrasse 13
DE-76829 Landau in der Pfalz
drklausfritz@drklausfritz.com
Conflict of Interests
Es besteht kein Interessenkonflikt
Literatur
1. Katsambas A, Antoniou C. Melasma: Classification and treatment. J Eur Acad Dermatol Venereol. 1995;4(3): 217-23.
2. Gupta LK, Singhi MK. Woods lamp. Indian J Dermatol Venereol Leprol. 2004; 70(2): 131-5.
3. Lee HI, Lim YY, Kim BJ, Kim MN, Min HJ, Hwang JH, et al. Clinicopathologic efficacy of copper bromide plus/yellow laser (578 nm with 511 nm) for treatment of melasma in Asian patients. Dermatol Surg. 2010;36(6): 885-93.
4. Pawaskar MD, Parikh P, Markowski T, McMichael AJ, Feldman SR, Balkrishnan R. Melasma and its impact on health-related quality of life in Hispanic women. J Dermatolog Treat. 2007; 18(l): 5-9.
5. Kim NH, Lee CH, Lee AY. H19 RNA downregulation stimulated melanogenesis in melasma. Pigment Cell Melanoma Res. 2010; 23(l): 84-92.
6. Perez M, SanchezJL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol. 1983; 81(6): 543-5.
7. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, et al. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009; 23(l l): 1254-62.
8. Bak H, Lee HJ, Chang SE, Choi JH, Kim MN, Kim BJ. Increased expression of nerve growth factor receptor and neural endopeptidase in the lesional skin of melasma. Dermatol Surg. 2009; 35(8): 1244-50.
9. Kim EH, Kim YC, Lee ES, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007; 46(2): 111-6.
10. Kim EJ, Park HY, Yaar M, Gilchrest BA. Modulation of mvascular endothelial growth factor receptors in melanocytes. Exp Dermatol. 2005; 14(8): 625-33.
11. Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, Kim My, et al. Localized intradermal microinjeetion of tranexamic acid for treatment of melasma in Asian patients: a preliminary clinical trial. Dermatol Surg. 2006; 32(5): 626-33.
12. Grimes PE, Yamada. N, Bhawan J. Light microscopic, immunohistochemical, and ultrastructural alterations in patients with melasma. Am J Dermatopathol. 2005; 27(2): 96-101.
13. Smit N, Vicanova J, Pavel S. The hunt for natural skin whitening agents. Int J Mol Sei. 2009; 10(12): 5326-49.
14. Katsambas AD, Stratigos AJ. Depigmenting and bleaching agents: coping with hyperpigmentation. Clin Dermatol. 2001; 19(4): 483-8.
15. Solano F, Briganti S, Picardo M, Ghanem G. Hypopigmenting agents: an updated review on biological, chemical and clinical aspects. Pigment Cell Res. 2006;19(6): 550-71.
16. Gillner M, Moore GS, Cederberg H. International programme on chemical safety panel of experts. Environmental health criteria 157: Hydroquinone. Available from: http://www. inchem.org/documents/ehc/ehc/ehcl57.htm
17. Farshi S. Comparative study of therapeutic effects of 20% azelaic acid and hydroquinone 4% cream in the treatment of melasma. J Cosmet Dermatol. 2011; 10(4): 282-7.
18. Deo KS, Dash KN, Sharma YK, Virmani NC, Oberai C. Kojic acid vis-a-vis its combinations with hydroquinone and betamethasone valerate in melasma: a randomized, single blind, comparative study of efficacy and safety. Indian J Dermatol. 2013; 58(4): 281-5.
19. Taylor MB, Yanaki JS, Draper DO, Shurtz JC, Coglianese M. Successful short-term and long-term treatment of melasma and postinflammatory hyperpigmentation using vitamin C with a full-face iontophoresis mask and a mandelic/malic acid skin care regimen. J Drugs Dermatol. 2013;12(l): 45-50.
20. Bissett DL, Miyamoto K, Sun P, Li J, Berge CA. Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin. Int J Cosmet Sci. 2004. 26(5): 231–238.
21. Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA, Kalil CL, Ayres EL, et al. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol. 20l4; 53(4): 440-4.
22. Sarkar R, Bansal S, Garg VK. Chemical peels for melasma in dark-skinned patients. J Cutan Aesthet Surg. 2012; 5(4): 247-53.
23. Rivas S, Pandya AG. Treatment of melasma with topical agents, peels and lasers: an evidence-based review. Am J Clin Dermatol. 2013; l4(5): 359-76.
24. Ara G, Anderson RR, Mandel KG, Ottesen M, Oseroff AR. Irradiation of pigmented melanoma cells with high intensity pulsed radiation generates acoustic waves and kills cells. Laser Surg Med. 1990; 10(1): 52-9.
25. Sharma, R. et al. Therapeutic efficacy and safety of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clinical and Experimental Dermatology (2017) 42: pp728–734.
26. Jo HY, Kim CK, Suh IB, Ryu SW et al. Co-localization of inducible nitric oxide synthase and phosphorylated akt in the lesional skins of patients with melasma. J Dermatol. 2009: 36(1): 10.
27. Kang HY, Hwang JS, Lee JY et al. The dermal stem cell factor and c-kit are overexpressed in melasma. Br J Dermatol. 2006; 154(6): 1094.
28. Regazzetti C, De Donatis GM, Ghorbel HH et al. Endothelial cells promote pigmentation through endothelin receptor B activation. J Invest Dermatol. 2015; 135(12): 3096.
29. Cayrili M, Caliskan E, Acikgoz G, Erbil AH, Ertuk G. Regression of Melasma with Platelet-Rich Plasma Treatment. Ann Dermatol 2014; 26: 401-2.
30. Gamea MM, Kamal DA, Donia AA, Hegab DS: Comparative study between topicaltranexamic acid alone versus its combination with autologous platelet rich plasma for treatment of melasma. J Dermatol Treat. 2020; 22: 1-7.
31. Hofny ERM, Abdel-Motaleb AA, Ghazally A, Ahmed AM, et al. Platelet rich plasma is a useful therapeutic option in melasma. J Dermatolog Treat. 2019; 30: 396-401.
32. Sirithanabadeekul P, Dannarongchai A, Suwanchinda A. Platelet-rich plasma treatment for melasma: A pilot study. J Cosmet Dermatol. 2019; 00:1–7.
33. Tuknayat A, Thami GP, Bhalla M, Sandhu JK. Autologous intralesional platelet rich plasma improves melasma. Dermatol Ther. 2021 Feb 16:e14881.
34. Yew CH, Ramasamy TS, Amini F. Response to intradermal autologous platelet rich plasma injection in refractory dermal melasma: report of two cases. JUMMEC. 2015; 18: 1-6.
35. Yang G, Li Y, Nishimura E, Xin H, et al. Inhibition of PAX3 by TGF-β modulates
melanocyte viability. Mol Cell 2008; 32: 554-63.