Chloasma melasma

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Figure 24-1. Pigmentary dermatoses. (Neutrogena Skin Care Institute) Cloasma of face.

CLINICAL LESIONS. An irregular hyperpigmentation of the skin that varies in shades of brown is seen. DISTRIBUTION. The lesions usually occur on the sides of the face, the forehead, and the sides of the neck. COURSE. The disorder is slowly progressive, but remissions do occur. It is more obvious in the summer.

ETIOLOGY. The cause is unknown, but some cases appear during pregnancy (called "mask of pregnancy") or with chronic illness. There is an increased incidence of chloasma in women taking contraceptive, postmenopausal, or fertility hormones. To be nosologically correct, such cases should be labeled drug eruption, hyperpigmentation, due to hormones. A lay term for chloasma is "liver spots," but there is no association with liver pathology. The melanocyte-stimulating hormone of the pituitary may be excessive and affect the tyrosine-tyrosinase enzyme system.

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