Spots of chloasma on face, body, arms and legs

Chloasma is a hyperpigmentation of a limited area of the facial skin. It is manifested by the appearance of pigmented spots of a brownish hue. This is an acquired disease caused by excessive accumulation of melanin in the upper layers of the skin. 

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Epidemiology

According to statistics, women are more vulnerable to chloasma, only in 10% of cases, men are carriers of this pathology. Most often they are sick at the age of 20 to 50 years. People who have a good reaction to a tan with a swarthy skin

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Causes of the chloasma

To date, there are no reliable statements regarding what exactly is the primary cause of the occurrence of chloasma. This pathological condition is associated with impaired metabolism of melanin pigment. Most likely, this is due to endocrine and hormonal disorders in the body.

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Risk factors

Allocate risk factors that can contribute to the development of chloasma:

• female;
• pregnancy;
• presence of hormonal disorders;
• diseases of the female reproductive system;
• prolonged exposure to UV rays, in particular, frequent visits to the solarium, a long stay in the sun;
• genetic predisposition, that is, the presence in family history of relatives with chloasma;
• chronic liver disease;
• reception of oral contraceptives;
• hormone-synthesizing tumors;
• pathology of the digestive tract;
• hypo- or avitaminosis;
• metabolic disorders;
• helminthic invasion;
• malaria;
• tuberculosis;
• damage to the epidermis as a result of careless extrusion of acne
• use of cosmetics that do not fit a certain type of skin, are poor-quality products and have a negative impact on the skin;
• hormone-containing therapy;
• diseases of the central nervous system;
• pathology of the endocrine system.

[6], [7], [8], [9], [10], [11], [12]

Pathogenesis

The pathogenesis of the disease is directly related to the accumulation of melanin-containing substances in a certain cutaneous area, which are deposited in the epidermis and dermis.

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Symptoms of the chloasma

Chloasma is manifested by the appearance of a hyperpigmented area of the skin, which has limited uneven edges. It has no elevation above the skin. For each person, chloasma can have its own shade with a predominantly brown color. The size of the area of increased pigmentation may be different: from a few millimeters to a large zone of damage.

Pigmentations have a single character, but if they are located at a minimum distance from each other, then the impression of a multiple lesion can be created. Soreness and itching are not typical for them. Patients may experience aesthetic discomfort.

Diagnostic places on which it is most often possible to detect the appearance of symptoms of chloasma are the forehead, the area around the eyes, the nose, the upper lip, the cheeks. Also, in rare cases, hyperpigmentation can be seen on the chest, on the back, near the midline of the abdomen and on the inner thigh surfaces, on the legs.

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Forms

There are several varieties of chloasma. One of them is perioral chloasma, which is diagnosed in female individuals. It manifests itself symmetrically located brown spots around the mouth. This type of chloasma has a long flow, with time the saturation of the spots can be changed, and areas of hyperpigmentation appear on the nasolabial folds.

The pigment line is also considered a kind of chloasma. This is a dyschromic form that can be recognized by the appearance of a pigmented strip having a width of about 10 mm that is localized on the forehead, passes through the cheek to the outside of the neck. However, this is a harbinger of serious diseases associated with impaired functioning of the nervous system, such as: brain tumor, parkinsonism, meningovascular syphilis.

Chloasma can be a manifestation of diseases of internal organs. For example, with cirrhosis, hepatitis, functional and organic lesions of the liver, dysfunction of the biliary tract, there may be a so-called hepatic chloasma, which is the reason to consult a doctor and conduct a medical examination.

The skin is a hormone-dependent organ, so it is often diagnosed with chloasma caused by taking oral contraceptive medications that change the hormonal background of a woman and are the cause of a violation of melanin metabolism.

Chlamas of pregnant women also arise against the background of the sensitivity of the skin of a woman to the influence of UV rays due to the elevated level of estrogens in the body. It is characterized by special lesions - nipples of the mammary glands and external genitalia. It is believed that hyperpigmentation during child bearing does not require treatment. If the initial cause of the appearance of age spots is pregnancy, then after birth they must disappear.

Chloasma in children is diagnosed extremely rarely.

Complications and consequences

Chloazma has no complications that could affect the life of a person. It can cause aesthetic discomfort. If hyperpigmentation occurs as a result of diseases of the internal organs, complications can arise due to untimely treatment of these diseases.

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Diagnostics of the chloasma

Diagnosis of chloasma is based on several types of examination. To begin with, the doctor should evaluate the appearance of the affected area of the skin, collect an anamnesis of life and disease, clarify the inherent pigmentation spot and acquired, check for the presence of an inflammatory process.

Assign specific diagnostic methods. This dermatoscopy (a study of the hyperpigmented skin area with the help of a dermatoscope, thanks to which a tenfold increase in the field of vision can be obtained) and siascopy (a study using a siascaner that allows to see the microscopic structure of pigment-containing cells), a skin biopsy can be prescribed .

After this, they begin laboratory research. The patient gives a general blood test, a general urine test, a biochemical blood test, a coprogram. To exclude the liver type of disease or chloasma, caused by diseases of internal organs, appoint biochemical hepatic assays, analysis for dysbiosis, gastroscopy, ultrasound of the abdominal cavity and liver. For women, an examination of the gynecologist is necessary to eliminate pathology associated with dysfunction of the reproductive system.

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Differential diagnosis

When diagnosing "chloasma", differential diagnosis is performed with a variety of diseases caused by a disorder in the metabolism of melanin.

For example, the pigmented spot also represents a skin area with enhanced pigmentation. However, depending on the type of pigmentation spot, it can have a flat office, appear on any part of the body, in contrast to the chloasma, which is manifested by a brown spot with uneven borders and has favorite places on the body where it most often appears.

Chloasma and Lentigo also have some similarities. Lentigo is a skin disease that is most often diagnosed in people after 40 years of age. In this case, the spots are round or oval, they can rise above the level of the skin, is a risk factor for the development of tumor-like diseases.

Treatment of the chloasma

In order for the treatment to yield a positive result, it is necessary to find out the original cause, which provoked the development of this disease. For example, if chloasma is a consequence of a hormonal imbalance, prescribing drugs that correct this condition, or changing oral contraceptives, if that was the reason. Treatment of hepatic chloasma includes hepatoprotectors and drugs needed to restore liver dysfunction.

There are also other ways of treatment.

Under the action of laser or chemical peeling, the upper layer of the skin is removed. This method is effective only in the case of not deep-lying spots.

For the treatment of chloasma, fractional or neodymium lasers are used. The first removes cells with a high content of melanin, affecting the surrounding tissue, the second - more sparing in this regard.

Photocorrection is carried out due to exposure to the skin by light pulses of high density, as a result of which the melanin-containing pigment is destroyed.

Mesotherapy is one of the effective methods of treating chloasma, in which a person injecting into the skin a solution containing useful vitamin complexes, such as: ascorbic acid, glycolic acid. They help suppress the activity of cells containing melanin and destroy it.

Bleaching ointments and creams, which include melanin precursor inhibitors, color pigment formation inhibitors, such as: hydroquinone, azelaic acid, arbutin. Examples can be various ointments: 5% hydroquinone ointment, Achromine, Melan.

In vitamin therapy includes the intake of folic acid, ascorbic, vitamin B, riboflavin.

There are a number of alternative recipes for the treatment of chloasma at home:

• applying a cotton swab on the hyperpigmentation section of a mixture of hydrogen peroxide and lemon juice;
• Gauze soaked in milk, falls on the chloasma for 20 minutes;
• wiping the skin with infusion of camomile flowers;
• with the help of a cotton disc is applied for 20 minutes on the affected skin, a decoction of parsley and lemon juice.

Prevention

Prevention of chloasma includes:

• avoid long exposure to sunlight on the skin, especially in the summer;
• use of sunscreen;
• application of natural sunscreen: hat, bandana, panama, cap, umbrella, glasses;
• Do not wear clothes that can cause rubbing;
• Avoid contact with chemicals that adversely affect the skin (gasoline, engine oil);
• carefully select oral contraceptives after consulting a gynecologist;
• Do not use substandard cosmetics that does not fit your skin type;
• pass the annual prof. Inspection to prevent the development of diseases of internal organs;
• have a healthy full diet, replenishing the body with enough vitamins, electrolytes, useful metabolites.

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Forecast

The forecast for life and work of a person is favorable.

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