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MelasmaAka: Chloasma, Mask of pregnancy

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  1. See Also
    1. Hyperpigmentation
    2. Hyperpigmentation in Pregnancy
  2. Definition
    1. Chloasma from Greek: "Greenish tint of growing bud"
  3. Causes
    1. Pregnancy (affects 70% of pregnant women)
      1. See Hyperpigmentation in Pregnancy
      2. Usually during second and third trimesters
      3. Resolves after delivery
      4. Often darker with subsequent pregnancies
    2. Oral Contraceptives
    3. Phototoxic Reaction (e.g. Phenytoin)
    4. Hyperthyroidism
    5. Liver disease
  4. Signs
    1. Hyperpigmented brown flat macular patch
    2. Distribution (usually symmetric)
      1. Cheeks (especially below eyes)
      2. Forehead and bridge of nose
      3. Upper lip
    3. Provocative factors (darkening)
      1. Sun Exposure
  5. Management: Antepartum
    1. Prevent Sun Exposure with high potency Sunscreen
  6. Management: Postpartum
    1. Prevent Sun Exposure with high potency Sunscreen
    2. Hydroquinone bleaching creams
      1. May be used in combination with Tretinoin (Retin A)
      2. Use for 3-4 weeks
      3. Use with Sunscreen
        1. SPF 50 over the melasma areas
        2. SPF 15 over other areas of the face
      4. Adverse effects
        1. Hypopigmentation
          1. Use caution in patients with darker skin
        2. Skin sensitizer
          1. Test daily for 2 days on arm first
      5. Preparations
        1. Hydroquinone 2% (Porcelana) is over the counter
        2. Hydroquinone 3-4% is prescription only
          1. Eldopaque available with sun block
        3. Hydroquinone, Tretinoin, Fluocinolone (Tri-Luma)
          1. Preferred agent by some dermatologists
          2. Torok (2005) Cutis 75:57
    3. Retin A
      1. Potentiates hydroquinone skin penetration
      2. Reduces pigment over months
    4. Chemical Peel
      1. Performed by Dermatology
      2. Risk of Hyperpigmentation in darker skin patients
  7. References
    1. Habif (1996) Dermatology, p. 622-3
    2. Stambuk in Gabbe (2002) Obstetrics, p. 1283

Chloasma (C0025218)

ConceptsDisease or Syndrome (T047)
ICD9374.52
MSHD008548
EnglishChloasma, Chloasmas, Melasma, Melasmas
Spanishcloasma, melasma
Parent ConceptsOvarian Diseases (C0029928), Pigmentation Disorders (C0549567), Skin endocrine disorder (C0553665), Chloasma (C0025218), Acquired hypermelanotic disorder (C0406412), Disorder of skin AND/OR subcutaneous tissue of head (C1290028), Disorder of face (C1290857), Skin Pigmentation Disorder (C1704421), Duplicate concept (C1274013)
SourcesCOSTAR, CST, DXP, MSH, MTH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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