Monday, January 27

Melasma in men

Melasma in men
Melasma is an acquired hypermelanosis affecting both men and women of Hispanic and Asian origin. Melasma is predominantly a female problem and only 10% of the affected individuals are men.
The localized hyperpigmentation is light to dark brown color. In chronic and deep-seated cases the lesions may appear grayish brown. Melasma in men is found to occur commonly on the face and sometimes also on the arms and neck.

The clinico-histological patterns and characteristics of melasma in men appear very similar to those of the lesions affecting women. Genetic susceptibility and environmental triggers are similar in both the genders. However the endocrine and hormonal factors, especially female hormones, do not seem to play a significant role in men, perhaps being subtle.

Shaving and the use of soap, after-shave, lotions, perfumes and facial sprays are important triggering factors in susceptible individuals. Three localized patterns of the hyperpigmentation are observed. They are centrofacial, malar, and mandibular hypermelanosis. Centrofacial pattern is present on the forehead, cheeks, nose and upper lips. Malar pattern is seen on the cheeks and nose. Mandibular pattern is present on the jawline. Examination of the lesions with ultraviolet light from Wood's lamp reveal that these lesions have epidermal, dermal or mixed location/origin.

The clinical, aetiological and histological study undertaken by R.Sarkar et al of Department of Dermatology, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, India on melasma in men has thrown light on the causative factors. When statistically compared with women, sun-exposure and family history are the predominant factors causing melasma in men. The clinicohistopathological characteristics are similar to those in women. Though more common in women, melasma is more frequently (20.5%) observed in Indian men when compared with global scenario.

Compared with healthy persons, 'Dermatology Life Quality Index' (DLQI) scores in melasma affected have been found to be high, indicating a poor quality of life (QOL). A study by R.Pichardo et al concluded that "melasma is a common condition in Latino men associated with quality of life".

There are several options available for the . The foremost is the sun protection. Reducing exposure to direct sunlight is necessary. The American Academy of Dermatology (AAD) recommends use of sunscreen with SPF 30+ to protect from both ultraviolet A and ultraviolet B radiations. For more information read the post 'melasma treatment'.

The use of skin lightening agents like tretinoin, hydroquinone, azelaic acid, glycolic acid, kojic acid, corticosteroids and formulations combining two or more of these agents is effective. Kligman's triple combination formula of 2% hydroquinone, 0.025% tretinoin, and 1% steroids (mometasone) has been proved to be the most effective in resolving melasma, especially epidermal lesions. Chemical peels, laser therapy and dermabrasion show limited success.

1.Vachiramon V, Suchonwanit P, Thadanipon K. Melasma in men. J Cosmet Dermatol. 2012 Jun;11(2):151-7.
2.Vázquez M, Maldonado H, Benmamán C, Sánchez JL. Melasma in men. A clinical and histologic study. Int J Dermatol. 1988 Jan-Feb;27(1):25-7.
3.Sarkar R, Puri P, Jain RK, Singh A, Desai A. Melasma in men: a clinical, aetiological and histological study. Journal of the European Academy of Dermatology and Venereology. 2010 Jul;24(7):768-72.
4.Rita Pichardo, Quirina Vallejos, Steven R. Feldman, Mark R. Schulz, Amit Verma, Sara A. Quandt, and Thomas A. Arcury. The Prevalence of Melasma and Its Association with Quality of Life among Adult Male Migrant Latino Workers. Int J Dermatol. 2009 January; 48(1): 22–26.
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