Facial Spots (Melanosis)

Facial Spots (Melanosis). It is the darkening of the facial skin also known as chloasma, “cloth” or “pregnancy mask” when it occurs in women during pregnancy, it is a hyperchromia or increased pigment that manifests in areas exposed to the sun, especially in the face.


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  • 1 Symptoms
  • 2 Causes
  • 3 Dignostic
  • 4 Treatment
  • 5 Sources


Although it can affect anyone , melasma affects more women , especially when they are pregnant and they had used oral contraceptives or hormones during hormone replacement therapy. Also against the consumption of certain antiepileptic drugs and other medicines.
The lesions are hipercrómicas spots ranging from a coffee very dark (epidermal or superficial melasma) to a pale bluish tone (or deep dermal melasma). These spots are veiled or finely speckled, with a poorly defined border and a smooth surface.
It appears on the cheeks and back of the nose (inbutterfly ), regions of the masseter muscles , chin, lips , forehead, but not beyond the maxillary lines. They have a very chronic evolution and without major discomfort, except for their obvious unsightly appearance.


There is no known cause, but female hormonal changes in estrogen levels and excessive sun exposure influence its appearance . It occurs in 75% of pregnancies, but not in all pregnancies of the same woman and usually disappears 3 months after delivery. Genetic predisposition is also a determining factor in the development of melasma.
The appearance of melasma is also more likely in patients with thyroid disorders. Overproduction of melanophores (MSH) in the pituitary gland of the brain is thought to be caused by stressit may be the cause. It is not uncommon to find people who have STRESS as the only factor for the appearance of melasma. Melasma is also believed to be an allergic reaction to medications and cosmetics .
Causes of increased acquired facial pigmentation also include:

  • Systemic diseases (endocrinopathies, connective tissue diseases, porphyria, hemochromatosis, storage diseases, nutritional deficits).
  • Neoplasms (metastatic melanoma, ACTH-producing tumors).
  • Drugs (tetracyclines, thiazides, amiodarone, chlorpromazine, phenothiazines, imipramine, phenytoin, chemotherapy).
  • Photosensitization by drugs or by plants (phototoxic reactions and photoallergies, berloque dermatitis)
  • Post-inflammatory hyperpigmentation (after inflammatory skin rashes, toxicosis and dermatoses of any kind)
  • Radiation (solar, ionizing)
  • Dermatosis of unknown origin (Riehl’s melanosis, pigmentosum lichen planus, pigmented perioral erythrosis, among others).

There are several entities that present with exclusively facial hyperpigmentation, such as Riel’s melanosis, pigmented perioral erythrosis, and acquired circumscribed facial dermal melanocytosis (Hori nevus).
Riehl’s melanosis appears mainly in women and seems to be caused by the use of cosmetics, which is why some authors prefer to call it pigmented contact dermatitis. Perioral pigmented erythrosis consists of a post-inflammatory perioral hyperpigmentation typical of people with long-standing perioral dermatitis in which topical corticosteroid treatment has often been used.
Acquired circumscribed facial dermal melanocytosis appears in women in middle age of life, characterized by the presence of grayish-brown macules on the forehead, temporal region, eyelids, malar region and nasal dorsum, clinically similar to Nevus of Ota. There are other diseases with hyperchromic macules. Actinic lichen planus appears in individuals that are exposed to the sun for a long time, so it usually appears in spring or summer and fades during winter.
It occurs more frequently in women and during the third decade of life, manifesting as hyperpigmented circinate or annular macules with a tendency to coalescence, located in the cephalic pole and practically asymptomatic. Lichen planus pigmentosum, ashy dermatitis, ashy dermatosis or dyschromic erythema perstans consists of the appearance of hyperpigmented macules, preceded or not by erythema, in any area of ​​the body, but much more commonly on the trunk and extremities.
Finally, there are drugsthat produce lichenoid-type reactions, such as gold, arsenical derivatives, mepacrine, quinine, quinidine, streptomycin, and penicillamine. This makes it mandatory for all cases of facial melanosis to be studied by the dermatologist and then establish a natural comprehensive treatment that covers not only the face.


Melasma is usually diagnosed simply by sight or with the help of a Wood’s lamp, with which excess melanin in the skin can be easily distinguished.


Melasma is considered one of the most difficult to treat dermatological pathologies, and patients frequently suffer rebounds of increasingly stubborn spots due, among other things, to the fact that they are in a hurry to perform procedures that are only aesthetic, and since in dermatology conventionally practically only this has been done.
There are two parts to the treatment of melasma, one part is the internal treatment that is intended to reduce or nullify the conditions that cause the spots and an external or aesthetic dermo-cosmetic treatment. General care – Photo protection. Photo sunscreen protectors should be used three times a day, both in front of natural light and artificial lights and television or computer monitors. -Cosmetic camouflage with dermatologically tested hypoallergenic products.
Depigmenting agents. In relation to depigmenting agents, there is a wide range of depigmenting agents. All these agents make it possible to whiten the skin, often only temporarily, the reappearance of melasma being quite frequent shortly after stopping treatment. These products are handled by the dermatologist, topical formulations are made.
Peeling. It is the application of a substance on the skin causing skin exfoliation and skin turnover. A whiter skin is obtained and pigmented epidermis is replaced with new skin. The alpha hydroxy acid peels and phytopeeling are performed periodically; During the treatment the patient can continue their normal activities and women can continue to apply makeup without any problem. Other stronger chemical and laser peels would only be indicated in some cases already previously treated and well controlled.


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