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Dermoscopy of another melasma lesion revealing, in addition to the features seen in Figure 2, increased vascularity and telangiectasias (black arrows) (polarizing mode, ×20)
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... Reduction in dots and globules and pigmentation in the pseudoreticular network can be seen post treatment in these patients. [10] However, available sparse literature demands a larger number of studies are needed to assess the effectiveness of PRP in treating melasma in dark skin types. ...
... On the basis of modified MASI scoring melasma was categorized into mild (0-8), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16), and severe (16)(17)(18)(19)(20)(21)(22)(23)(24). ...
Background
Melasma is a common dermatosis in both men and women showing varying degrees of success with treatment. Relapse of melasma is high in dark skin types, which necessitates the need for finding a modality of treatment, which not only treats but also prevents relapse.
Aims
To study the effectiveness of platelet-rich plasma (PRP) in patients of melasma both clinically and dermoscopically in dark skin types.
Materials and Methods
A prospective study of 20 female patients of Fitzpatrick skin type IV–V with mixed type of melasma and bilateral involvement of the face were enrolled for the study. PRP was injected intradermally at 4 weeks interval for three sittings, and the results were assessed clinically (by modified melasma area and severity score) and dermoscopically. Patients were counselled to ensure strict sun protection measures. Patient satisfaction was noted at baseline, 4 weeks, 8 weeks, and 12 weeks. Patients were followed up for 3 months to see for any relapse of the pigmentation. The follow-up showed no relapse of melasma in these patients.
Statistical Analysis
Analysis of variance was used with Bonferroni correction for modified melasma area and severity score at various time interval. Subject global aesthetic improvement scale (SGAIS) and physician global esthetic improvement scale (PGAIS) were expressed in counts. P -value ≤ 0.05 was considered significant.
Results
Modified melasma area and severity score and dermoscopic changes showed statistically significant improvement compared at the end of study in mild to severe cases. The subjective assessment was made by PGAIS. Patient satisfaction levels (assessed by SGAIS) also showed significant improvement in successive weeks of treatment. Few patients had mild redness and burning post procedure, which resolved spontaneously after few hours.
Conclusion
From this study we concluded that PRP shows a significant improvement in melasma after 12 weeks of treatment with no relapse even after 3 months. Hence, PRP may be used not only as an adjuvant but also as a first line treatment in the view of longer sustained results when combined with strict sun protection. There is a paucity of studies showing results of PRP treatment in dark skin types, which is more resistant to treatment than lighter skin. Moreover, clinical improvement should not be the only parameter to decide on stopping treatment as chances of relapse can be higher. Dermoscopic evaluation helps in determining the changes in vasculature (telangiectasias) and pigmentation (dots and globules), which are better indicators of success of treatment.
... When exposed to UV light in a dark environment, the pigmented skin is clearly visible, and the dark border becomes fluorescent [13]. Moreover, with Wood's lamp, superficial or epidermal melasma is usually seen more clearly under light, whereas deep or dermal melasma shows no particular changes [14]. ...
... When examined with a dermoscope, in superficial or epidermal melasma, a network of brown reticulated islands with dark and small seeds can be seen scattered [14]. Reflectance confocal microscopy can be used in cellular evaluation in patients with melasma. ...
When we were thinking about the title for the introductory chapter, naturally, the most common pigmentation diseases were the priority [1]. In other chapters of the book, vitiligo was discussed from both psychological and clinical aspects. On the other hand, the clinical course of melasma and post-inflammatory hyperpigmentation was present in other chapters, but there was no room for a psychological discussion of melasma patients and its effects on the patient’s quality of life. Melasma is a characteristic pattern of marginated facial hyperpigmentation, occurring primarily on the face. The cause of melasma is not completely known, but pregnancy, estrogen therapy, exposure to sunlight and ultraviolet light, and positive family history in Caucasian patients are well known [2]. Melasma is more common in women and non-Caucasian people, although it has been seen in men of all races [2, 3]. Melasma can have significant emotional and psychological impacts on patients. The 10-item the Melasma Quality of Life (MELASQOL) scale was devised from the comprehensive Health-Related Quality of Life (HRQoL) assessment set [4, 5]. HRQoL is a scale used to define the social, physical, and psychological well-being of an individual and to evaluate the distress of disease on daily living [6, 7]. In this chapter, we will concisely review the clinical aspects, treatments, and the impact of melasma on the quality of life (QoL) of the patients.
... However, we were not able to demonstrate a statistically significant relationship between UV light exposure and the presence of increased vascularity and telengiectasia via dermoscopic examination (p = 0.544). Sonthalia et al. [21] reported a case of 35-yearold female patient who was diagnosed with centrofacial melasma and never used sunscreen before. Polarized videodermoscopy of the patients showed a pseudoreticular pigment network, brown globules/granules, increased vascularity, telangiectasias and arcuate-annuar structures [21], which further supports the relationship between UV exposure and the presence of increased vascularity and telengiectasia upon dermoscopic examination. ...
... Sonthalia et al. [21] reported a case of 35-yearold female patient who was diagnosed with centrofacial melasma and never used sunscreen before. Polarized videodermoscopy of the patients showed a pseudoreticular pigment network, brown globules/granules, increased vascularity, telangiectasias and arcuate-annuar structures [21], which further supports the relationship between UV exposure and the presence of increased vascularity and telengiectasia upon dermoscopic examination. ...
Melasma is an acquired, pigmentary disorder characterized by the appearance of brown to bluish-gray patches with welldemarcated or ill-defned borders, most commonly on the face. This challenging hyperpigmentation disorder is generally
observed in women; sun exposure, pregnancy, oral contraceptive use, genetic infuences and chemical agents are some
etiopathogenetic factors. Even though readily diagnosed by clinical examination; dermoscopy, Wood lamp fndings and
histopathology may also help the clinicians to confrm the diagnosis and to disclose the features of the melasma such as
melanin depth and melasma type. In our study, we aimed to investigate the dermoscopic properties of facial melasma in
accordance with diferent skin phototypes, age, distribution patterns, presence of other facial dermatoses, etiological factors
and wood lamb fndings. In the present cross-sectional study, patients clinically diagnosed with facial melasma in a secondary care hospital were included. Demographical data, personal history, distribution patterns of the melasma, dermoscopic
features, Wood lamp examination fndings, the presence of any other facial dermatosis, possible underlying risk factors
and skin phototypes were determined. One hundred ffty nine patients with a total number of 236 melasmas with variable
distribution patterns were included. The mean age was 37.91 years, whereas the mean age at the onset of the melasma was
32.43 years. One hundred thirty three participants were females, whereas 26 were males. The most prevalent risk factors
of melasma were exposure to UV light (62.2%), pregnancy (50.6%) and genetic predisposition (43.6%). The most common
melasma localization was cheek (43.6%) followed by T zone (33.1%). The most common dermoscopic fndings were brown
reticular pseudonetwork (73.3%), increased vascularity and telangiectasia (51.7%) and brown clods (33.1%). Brown reticular
pseudonetwork was present at a higher rate in patients with skin phototype V compared to the ones with skin phototype II
(p=0.033). Our study shows that dermoscopic fndings of melasma may difer across diferent skin phototypes, melasma
localizations, possible associated risk factors and age.
... Dermoscopic features of facial melasma include diffuse brown pigmentation, pseudoreticular network, brown dots and globules, arcuate and annular structures, sparing of follicular openings and presence of telengiectasias. [4] We observed similar dermoscopic features in extrafacial melasma along with linear streaks and criss-cross pattern over forearms and presence of seborrheic keratosis. Linear streaks signify presence of photodamaged skin. ...
Background:
Extrafacial melasma is a rare presentation, commonly occurring in postmenopausal women with a poor etiological insight and nature of its course. We planned to decipher the natural course of extrafacial melasma based on history questionnaire.
Materials and methods:
Patients with diagnosis of extrafacial melasma were recruited. After informed consent, complete history including age of onset, duration, progression, sites of involvement (initial site as well as current site of pigmentation), treatment history, history of drug intake, family history, associated other diseases, and clinical photography and dermoscopy were done.
Results:
Fifteen extrafacial melasma patients were recruited. All were females with mean age of 51.2 years. History of facial melasma in past was given by 93% of recruited patients. Mean total duration of melasma was 23 years. Ten (66%) patients had centrofacial melasma to begin with, 4 (26%) patients had malar melasma, and 1 (6.6%) had extrafacial melasma as initial presentation. Currently all patients had extrafacial melasma. Mean time for clearance of central face melasma was 18.2 years and appearance of melasma at extrafacial sites was 20 years.
Conclusions:
We infer that different clinical patterns of melasma occur sequentially over the natural course of disease and centrofacial melasma as the initial presentation in majority of our patients, progressed to involve extrafacial sites with time.
... [8] On dermoscopy, the commonly observed pattern is light to dark brown background with granules, globules, and perifollicular sparing. [9] Dermoscopic pattern is clinically correlated as this enhances the diagnostic accuracy. Dermoscopy in melasma can be used to determine the depth of melasma, to differentiate it from other causes of facial melanosis, and to assess the prognosis of melasma. ...
... A study done by Sonthalia et al. also reported similar findings, which are diffuse brown pseudoreticular network, brown dots, granules, globules, and arcuate and annular structures with sparing of the perifollicular region. [9] Gupta and Sarkar also reported similar findings, which are reticular pigment network and perifollicular sparing with color varying from light brown to dark brown. [18] Dermoscopy can be used where facial pigmentation is difficult to differentiate from other conditions (e.g., lichen planus pigmentosus, Reihl's melanosis, ochronosis) or where melasma is not responding to treatment. ...
... The examined dermoscopic features of mixed melasma included; reticuloglobular pigmentation (epidermal melasma features), arcuate, honeycomb, and pseudoreticular pigmentation (dermal melasma features) in addition to the presence or absence of telangiectasia. 12 The examined criteria were evaluated as present or not (+ or À). ...
Background
Melasma is a common esthetic problem affecting the face with a lot of risk factors being incriminated. Although several treatment options are available, none of them is satisfactory.
Objective
This split face prospective study aimed to compare the efficacy of microneedling with vitamin C versus with PRP in the management of mixed melasma.
Methods
Ten females with bilateral mixed facial melasma were treated with six sessions of microneedling. After the needling vitamin C was applied on the right side of the face and PRP was applied on the left side. Clinical, dermoscopic, and histological assessment of the used treatments was done 1 month after the last session.
Results
The clinical and dermoscopic clearance of melasma was proved significantly on both sides of the face but was more significant with vitamin C (P = 0.005). Reduction of epidermal melanin and dermal melanophages was more observed with vitamin C. Moreover, MART-1 stain revealed a more significant reduction in the epidermal, dermal, and the total MART-1 positive cells with vitamin C (P =0.044, 0.039, and 0.035 respectively).
Conclusion
Microneedling with vitamin C was more efficient in treating mixed melasma than with PRP.
... 15 Furthermore, epidermal melasma usually displays accentuation under light, while dermal melasma shows none. 16 Dermoscopic evaluation of epidermal melasma shows predominantly brown colour, with scattered islands of brown reticular network with fine dark granules scattered on the surface. Dermoscopic features of dermal melasma include a brown-to-ash grey colour with a more uniform involvement with no areas of pigmentation sparing and a reticuloglobular pattern, telangiectasia and archiform structures. ...
... Dermoscopic features of dermal melasma include a brown-to-ash grey colour with a more uniform involvement with no areas of pigmentation sparing and a reticuloglobular pattern, telangiectasia and archiform structures. 16 Mixed melasma shows features of both epidermal and dermal subtypes. ...
Background: Melasma is a common disorder of hyperpigmentation of the skin, characterised by brown pigmentation primarily on the face. Given its frequent facial involvement, it has a significant impact on the quality of life of patients. Management can often be quite difficult, requiring extensive treatment periods and multiple modalities for ongoing maintenance.
Objective: To provide evidence-based clinical updates to clinicians, specifically general practitioners, to assist with their everyday practice, and effective assessment and treatment of melasma.
Discussion: Therapeutic modalities are chosen based on disease presentation, patient preference, treatment periods and side-effect profiles of treatment agents; often a combination of therapies is required.
... In contrast, melasma, a mimic of Hori's nevus in some cases, displays a reticular pattern with perifollicular sparing and even distribution of pigment. [13][14][15] Out of the 497 patients, 218 patients (44%) had lesions in yellow-brown color, and 176 patients (35%) had lesions in slate-grey color. The rest, 103 patients (21%), displayed blue-brown lesions. ...
Background
Hori’s nevus is a common pigmented disorder on the face, preferentially in females. The clinical features have not been well characterized.
Aim
To characterize the clinical features of Hori’s nevus in Chinese adults.
Subjects and Methods
Data were collected from files of patients who visited our hospital from 2015 to 2018. Age- and disease duration-related characteristics were analyzed.
Results
A total of 497 patients, including 486 females and 11 males, were included in this analysis. One fifth of the patients had a family history of Hori’s nevus. Over 70% of patients were aged 21–30 years. Age at onset was comparable between males and females (20.64 ± 1.01 vs 18.99 ± 0.24). Out of 497 subjects, 218 subjects (44%) displayed yellow-brown lesions while blue-brown lesions wwere observed in 103 subjects (21%). The rest (176 cases, 35%) showed slate-grey lesions. Involvement in the zygomatic area was observed in 496/497 subjects. Involvement in a single area accounted for 74% of patients, while two areas were involved in 19% of patients. The number of involved areas correlated positively with disease duration. However, the proportion of subjects with yellow-brown lesions correlated negatively with disease duration, while the proportion of subjects with slate-grey lesions correlated positively with disease duration. The proportion of subjects with lesions involving the lower eyelids, the root of the nose, the temple and the outer frontal area correlated positively with age.
Conclusion
Hori’s nevus mainly involves the zygomatic area in subjects aged 21–30 years. Lesion color is associated with age, age at onset, and disease duration.
... [29] MELASMA A pseudoreticular pigment network with concave borders (jelly sign), diffuse light-to-dark brown background with sparing of the periappendageal region (follicular and sweat gland openings), brown granules, and globules, including arcuate and annular structures is seen on dermoscopy [ Table 1]. [30] Epidermal melasma demonstrates blotchy brownish reticular pattern showing multiple granules and globules of dark brown color superimposed on reticular pattern. Dermal melasma shows grayish-brown or grayishblack pigmented specks or arcuate, star shaped, honeycomb, and annular structures mainly in perifollicular location sparing follicles. ...
... Pigmented contact dermatitis on dermoscopy shows uneven distribution of brown-to-gray-colored dots and globules with pseudo network of reticular network and erythematous background [ Table 1]. [30] EO Dermoscopy reveals blue-gray dots and globules with a caviar-like appearance with dark brown reticular network and background of dark hyperpigmentation with obliteration of follicular opening. Elongated and curvilinear wormlike structures conjoined together in a reticulate pattern of ochronosis. ...
... Confetti-like depigmentation seen as white dots [ Figure 9] and telangiectasias seen as red dots [ Table 1]. [30] ...
Facial pigmentary disorder is a common condition in dark-skinned individual which causes significant psychological morbidity to the patients. Some of the well-defined causes of facial melanoses include melasma, Riehl’s melanosis, lichen planus pigmentosus, erythema dyschromicum perstans, and poikiloderma of Civatte. However, most of these conditions share many clinical and histopathological features in common. Sunlight exposure is one of the most common etiological factors, but application of irritant and photochemical substances also plays a role. Treatment of facial pigmentation is difficult and involves mainly the usage of various skin lightening agents acting at different levels of melanogenesis such as hydroquinone, chemical peels, and lasers. There is no universally effective specific therapy – existing agents have varying degrees of efficacy and relapses are frequent. Dermoscopy has been used mostly in the evaluation of pigmented lesions which have shown superiority over clinical examination and is of immense help to the clinicians for the appreciation of subtle features which are invisible to the naked eye.
... One of the characteristic dermoscopic descriptive features of facial melanoses reported in a majority of previous cases and studies and in our own experience is the background color, [10][11][12] which is usually light-to-dark brown in lichen planus pigmentosus in darker skin types. In fact, in most of the dermoscopy figures in the study being discussed, there is a conspicuous diffuse light to dark-brown background, faint erythema along the exaggerated pigment network and larger dark-colored structures (clods or blotches), which have not been commented upon. ...
