Melasma Clinical Features, Diagnosis, Epidemiology and Etiology: An Update Review
DOI:
https://doi.org/10.33192/Smj.2021.109Keywords:
Melanin, melanocortin, melasmaAbstract
Melasma is one of the commonest dermatological challenges that facing dermatologists in the whole world. Most of the previously published articles regarding melasma usually focused on its management and the newly discovered drugs; however, the understanding of the suspected etiology and the pathogenesis is very critical to treat this skin disorder in a correct manner. Therefore, this review is an attempt to do a comprehensive updating on the present understanding of the melasma epidemiology, etiology, its role in pregnant, post-menopausal women, and in males, besides its clinical features and diagnosis through searching in many scientific databases including EMBASE, Cochrane Library, PubMed, Pubmed Central (PMC), Medline, Web of Science, and Scopus.
This review approaches recognizing the pathogenesis that can provide ideas to solve the therapeutic problems which connect to melasma. Therefore, this article is entirely established on previously performed studies so that no new studies on animal or human subjects were conducted by the author.
References
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4. Abdalla MA. Evaluation of Alpha-Melanocyte Stimulating
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[Dissertation]. Tikrit: Tikrit University College of Medicine;
2018.
5. Olejnik A, Glowka A, Nowak I. Release studies of undecylenoyl
phenylalanine from topical formulations. Saudi Pharm J. 2018;
26(5):709-718.
6. Sarkar R, Bansal A, Ailawadi P. Future therapies in melasma:
What lies ahead? Indian J Dermatol Venereol Leprol. 2020;86:
8-17.
7. Lee BW, Schwartz RA, Janniger CK. Melasma. J Ital Dermatol
Venereol. 2017;152(1):36-45.
8. Zubair R, Lyons AB, Vellaichamy G, Peacock A, Hamzavi I.
What’s New in Pigmentary Disorders? Dermatol Clin. 2019;37(2):
175-181.
9. Kwon SH, Na JI, Choi JY, Park KC. Melasma: Updates and
perspectives. Exp Dermatol. 2019;28(6):704-708.
10. Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics
and management of Asian skin. Int J Dermatol. 2019;58(2):131-
143.
11. Bagherani N, Gianfaldoni S, Smoller BR. An overview on melasma.
J Pigment Disord. 2015;2(10):218.
12. Abdalla MA, Nayaf MS. Evaluation of serum α-MSH Level in
Melasma. WJPMR 2018;4(5):29-32.
13. Roberts WE, Henry M, Burgess C, Saedi N, Chilukuri S, Campbell-
Chambers DA. Laser Treatment of Skin of Color for Medical
and Aesthetic Uses With a New 650-Microsecond Nd:YAG
1064nm Laser. J Drugs Dermatol. 2019;18(4):s135-137.
14. Abdalla MA, Nayaf MS, Hussein SZ. Evaluation of Vitamin D
in Melasma Patients. Rev Romana Med Lab. 2019;27(2):219-
21.
15. Passeron T, Genedy R, Salah L, Fusade T, Kositratna G, Laubach
HJ, Marini L, Badawi A. Laser treatment of hyperpigmented
lesions: position statement of the European Society of Laser in
Dermatology. J Eur Acad Dermatol Venereol. 2019;33(6):987-
1005.
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Knowledge in General Physicians. Siriraj Med J. 2016;68(2):79-
83.
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Role of broad-spectrum sunscreen alone in the improvement
of melasma area severity index (MASI) and Melasma Quality
of Life Index in melasma. J Cosmet Dermatol. 2019;18(4):1066-
1073.
19. Rodrigues M, Ayala-Cortes AS, Rodriguez-Arambula A, Hynan
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Diagnosis and Management. Am Fam Physician. 2017;96(12):797-
804.
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melasma during pregnancy. Int J Dermatol. 2006;45:285-288.
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Karavakul C. Comparison of Human Menopausal Gonadotrophin
Abdalla.
https://he02.tci-thaijo.org/index.php/sirirajmedj/index Volume 73, No.12: 2021 Siriraj Medical Journal 849
Review Article SMJ
and Recombinant Follicle-Stimulating Hormone in In-Vitro
Fertilisation and Pregnancy Outcome. Siriraj Med J. 2020;53(11):
805-10.
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Sinica. 2014;32(4):233-239.
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The dermal stem cell factor and c-kit are overexpressed in
melasma. Br J Dermatol. 2005;154:1094-1099.
28. Çakmak SK, Özcan N, Kiliç A, Koparal S, Artüz F, Çakmak A,
et al. Etiopathogenetic factors, thyroid functions and thyroid
autoimmunity in melasma patients. Postepy Dermatol Alergol.
2015;32:327-330.
29. Handel AC, Miot LD, Miot HA. Melasma: a clinical and
epidemiological review. An Bras Dermatol. 2014;89(5):771-
782.
30. Serban ED, Farnetani F, Pellacani G, Constantin MM. Role of
In Vivo Reflectance Confocal Microscopy in the Analysis of
Melanocytic Lesions. Acta Dermatovenerol Croat. 2018;26(1):
64-67.
31. Agozzino M, Ferrari A, Cota C, Franceschini C, Buccini P,
Eibenshutz L, Ardigò M. Reflectance confocal microscopy
analysis of equivocal melanocytic lesions with severe regression.
Skin Res Technol. 2018;24(1):9-15.
32. Thangboonjit W, Limsaeng-u-rai S, Pluemsamran T, Panich U.
Comparative Evaluation of Antityrosinase and Antioxidant
Activities of Dietary Phenolics and their Activities in Melanoma
Cells Exposed to UVA. Siriraj Med J. 2014;66(1):5-10.
33. Noh S, Choi H, Kim JS, Kim IH, Mun JY. Study of hyperpigmentation
in human skin disorder using different electron microscopy
techniques. Microsc Res Tech. 2019;82(1):18-24.
34. El-Sinbawy ZG, Abdelnabi NM, Sarhan NE, Elgarhy LH.
Clinical & ultrastructural evaluation of the effect of fractional
CO2 laser on facial melasma. Ultrastruct Pathol. 2019;43(4-5):
135-144.
35. Viac J, Palacio S, Schmitt D, Claudy A. Expression of vascular
endothelial growth factor in normal epidermis, epithelial tumors
and cultured keratinocytes. Arch Dermatol Res. 1997;289(3):158-
163.
36. Rahmatullah WS, Al-Obaidi MT, AL-Saadi WI, Selman MO,
Faisal GG. Role of Vascular Endothelial Growth Factor (VEGF)
and Doppler Sub-endometrial Parameters as Predictors of
Successful Implantation in Intracytoplasmic Sperm Injection
(ICSI) Patients. Siriraj Med J. 2020;72:33-40.
37. Grimes PE, Yamada N, Bhawan J. Light microscopic,
immunohistochemical and ultrastructural alterations in patients
with melasma. A J Dermatopathol. 2005;27(2):96-101.
38. Yan QU, Wang F, Junru L, Xia X. Clinical observation and
dermoscopy evaluation of fractional CO2 laser combined with
topical tranexamic acid in melasma treatments. J Cosmet
Dermat. 2021;20(4):1110-1116.
39. Sarkar R, Ailawadi P, Garg S. Melasma in men: A review of
clinical, etiological, and management issues. J Clin Aesthet
Dermatol. 2018;11(2):53-59.
40. Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA,
Kalil CL, Ayres EL, et al. Epidemiology of melasma in Brazilian
patients: a multicenter study. Int J Dermatol. 2014;53:440-444.
41. Kim HJ, Moon SH, Cho SH, Lee JD, Sung Kim H. Efficacy and
safety of Tranexamic acid in melasma: a meta-analysis and
systematic review. Acta Derm Venereol. 2017; 97(6-7):776-781.
42. Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. Risk
factors for facial melasma in women: A case-control study. Br
J Dermatol. 2014;171:588-594.
43. Nayaf MS, Ahmed AA, Abdalla MA. Alopecia Areata and
Serum Vitamin D in Iraqi Patients: A Case-Control Study.
Prensa Med Argent. 2020;106(3):287.
44. Gopichandani K, Arora P, Garga U, Bhardwaj M, Sharma N,
Gautam RK. Hormonal profile of melasma in Indian females.
Pigment Int. 2015;2:85-90.
45. Duteil L, Esdaile J, Maubert Y, Cathelineau AC, Bouloc A,
Queille-Roussel C, et al. A method to assess the protective
efficacy of sunscreens against visible light-induced pigmentation.
Photodermatol Photoimmunol Photomed. 2017;33(5):260-266.
46. Ching D, Amini E, Harvey NT, Wood BA, Mesbah Ardakani N.
Cutaneous tumoural melanosis: a presentation of complete
regression of cutaneous melanoma. Pathology. 2019;51(4):399-
404.
47. Abdalla MA, Nayaf MS, Hussein SZ. Correlation between serum
α-MSH and vitamin D levels in vitiligo patients. Iran J Dermatology.
2020;23(4):163-167.
48. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P,
et al. A global survey of the role of ultraviolet radiation and
hormonal influences in the development of melasma. J Eur
Acad Dermatol Venereol. 2009;23:1254-1262.
49. Goh CL, Chuah SY, Tien S, Thng G, Vitale MA, Delgado-Rubin
A. Double-blind, placebo-controlled trial to evaluate the
effectiveness of Polypodium leucotomos extract in the treatment
of melasma in Asian skin: A pilot study. J Clin Aesthet Dermatol.
2018;11(3):14-19.
50. Tamega Ade A, Miot HA, Moco NP, Silva MG, Marques ME,
Miot LD. Gene and protein expression of oestrogen-beta and
progesterone receptors in facial melasma and adjacent healthy
skin in women. Int J Cosmet Sci. 2015;37(2):222-228.
51. Niwano T, Terazawa S, Sato Y, Kato T, Nakajima H, Imokawa
G. Glucosamine abrogates the stem cell factor + endothelin-
1-induced stimulation of melanogenesis via a deficiency in
MITF expression due to the proteolytic degradation of CREB
in human melanocytes. Arch Dermatol Res. 2018;310:625-637.
52. Vâradi J, Harazin A, Fenyvesi F, Reti-Nagy K, Gogolâk P,
Vâmosi G, et al. Alpha- Melanocyte Stimulating Hormone
Protects against Cytokine-Induced Barrier Damage in Caco-2
Intestinal Epithelial Monolayers. PLOS ONE. 2017;12(1):e0170537.
53. Fearce CT, Swope V, Abdel-Malek Z. The Use of Analogs of
α-MSH as Tanning Agents for the Prevention of Melanoma.
FASEB J. 2016;30(1):1500-1509.
54. Saleh AA, Salam OHA, Metwally GH, Abdelsalam HA, Hassan
MA. Comparison Treatment of Vitiligo by Co-culture of
Melanocytes Derived from Hair Follicle with Adipose-Derived
Stem Cells with and without NB-UVB. Pigmentary Disorders.
2017;4:256.
55. Sarma N, Chakraborty S, Poojary SA, Rathi S, Kumaran S, Nirmal
B, et al. Evidence-based review, grade of recommendation,
and suggested treatment recommendations for melasma.
Indian Dermatol Online J. 2017;8(6):406-442.
56. Passeron T, Picardo M. Melasma, a photoaging disorder.
Pigment Cell Melanoma Res. 2018;1-5.
57. Kim SW, Yoon HS. Tamoxifen-induced melasma in a
postmenopausal woman. J Eur Acad Dermatol Venereol.
2009;23:1199-1200.
850 Volume 73, No.12: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/index
58. Rija FF, Hussein SZ, Abdalla MA. Physiological and Immunological
Disturbance in Rheumatoid Arthritis Patients. Baghdad Sci J.
2021;18(2):247-252. doi: 10.21123/bsj.2021.18.2.0247
59. Abdalla MA. Pneumatization patterns of human sphenoid sinus
associated with the internal carotid artery and optic nerve by CT
scan. Ro J Neurol. 2020;19(4):244-251. doi: 10.37897/RJN.2020.4.5.
60. Prabha N, Mahajan VK, Mehta KS, Chauhan PS, Gupta
M. Cosmetic Contact Sensitivity in Patients with Melasma:
Results of a Pilot Study. Dermatology Research and Practice.
2014; 316219: 9.
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Rook’s Textbook of Dermatology. 9th Edition. Oxford: Wiley-
Blackwell Publishing Ltd; 2017.
2. Habif TP. Clinical Dermatology: A Colour Guides to Diagnosis
and Therapy. 6th Edition. Philadelphia: Elsevier Health Sciences;
2016.
3. Goldsmith LA,Katz SI,Gilchrest BA,Paller AS,Leffell DJ,
Wolff K. Fitzpatrick’s Dermatology in General Medicine. 8th
Edition. New York: McGraw-Hill Higher Education; 2012.
4. Abdalla MA. Evaluation of Alpha-Melanocyte Stimulating
Hormone and Vitamin D in patients with Vitiligo and Melasma.
[Dissertation]. Tikrit: Tikrit University College of Medicine;
2018.
5. Olejnik A, Glowka A, Nowak I. Release studies of undecylenoyl
phenylalanine from topical formulations. Saudi Pharm J. 2018;
26(5):709-718.
6. Sarkar R, Bansal A, Ailawadi P. Future therapies in melasma:
What lies ahead? Indian J Dermatol Venereol Leprol. 2020;86:
8-17.
7. Lee BW, Schwartz RA, Janniger CK. Melasma. J Ital Dermatol
Venereol. 2017;152(1):36-45.
8. Zubair R, Lyons AB, Vellaichamy G, Peacock A, Hamzavi I.
What’s New in Pigmentary Disorders? Dermatol Clin. 2019;37(2):
175-181.
9. Kwon SH, Na JI, Choi JY, Park KC. Melasma: Updates and
perspectives. Exp Dermatol. 2019;28(6):704-708.
10. Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics
and management of Asian skin. Int J Dermatol. 2019;58(2):131-
143.
11. Bagherani N, Gianfaldoni S, Smoller BR. An overview on melasma.
J Pigment Disord. 2015;2(10):218.
12. Abdalla MA, Nayaf MS. Evaluation of serum α-MSH Level in
Melasma. WJPMR 2018;4(5):29-32.
13. Roberts WE, Henry M, Burgess C, Saedi N, Chilukuri S, Campbell-
Chambers DA. Laser Treatment of Skin of Color for Medical
and Aesthetic Uses With a New 650-Microsecond Nd:YAG
1064nm Laser. J Drugs Dermatol. 2019;18(4):s135-137.
14. Abdalla MA, Nayaf MS, Hussein SZ. Evaluation of Vitamin D
in Melasma Patients. Rev Romana Med Lab. 2019;27(2):219-
21.
15. Passeron T, Genedy R, Salah L, Fusade T, Kositratna G, Laubach
HJ, Marini L, Badawi A. Laser treatment of hyperpigmented
lesions: position statement of the European Society of Laser in
Dermatology. J Eur Acad Dermatol Venereol. 2019;33(6):987-
1005.
16. Leelaudomlipi P. Melasma. Siriraj Med J. 2007;59(1):24-5.
17. Leeyaphan C. Wood’s Lamp Examination: Evaluation of Basic
Knowledge in General Physicians. Siriraj Med J. 2016;68(2):79-
83.
18. Sarkar R, Ghunawat S, Narang I, Verma S, Garg VK, Dua R.
Role of broad-spectrum sunscreen alone in the improvement
of melasma area severity index (MASI) and Melasma Quality
of Life Index in melasma. J Cosmet Dermatol. 2019;18(4):1066-
1073.
19. Rodrigues M, Ayala-Cortes AS, Rodriguez-Arambula A, Hynan
LS, Pandya AG. Interpretability of the modified melasma area
and severity index (mMASI) JAMA Dermatol. 2016;152(9):1051-
1052.
20. Handa S, De D, Khullar G, Radotra B, Sachdeva N. The
clinicoaetiological, hormonal and histopathological characteristics
of melasma in men. Clin Exp Dermatol. 2018;43(1):36-41.
21. Chinhiran K, Leeyaphan C. Posaconazole Induced Diffuse
Lentigines: A Case Report. Siriraj Med J. 2018;70(2):182-3.
22. Plensdorf S, Livieratos M, Dada N. Pigmentation Disorders:
Diagnosis and Management. Am Fam Physician. 2017;96(12):797-
804.
23. Moin A, Jabery Z, Fallah N. Prevalence and awareness of
melasma during pregnancy. Int J Dermatol. 2006;45:285-288.
24. Phophong P, Choavaratana R, Suppinyopong S, Loakirkkiat P,
Karavakul C. Comparison of Human Menopausal Gonadotrophin
Abdalla.
https://he02.tci-thaijo.org/index.php/sirirajmedj/index Volume 73, No.12: 2021 Siriraj Medical Journal 849
Review Article SMJ
and Recombinant Follicle-Stimulating Hormone in In-Vitro
Fertilisation and Pregnancy Outcome. Siriraj Med J. 2020;53(11):
805-10.
25. Lee AY. An updated review of melasma pathogenesis. Dermatologica
Sinica. 2014;32(4):233-239.
26. Lee AY. Recent progress in melasma pathogenesis. Pigment
Cell Melanoma Res. 2015;28(6):648-660.
27. Kang HY, Hwang JS, Lee JY, Ahn JH, Kim JY, Lee ES, et al.
The dermal stem cell factor and c-kit are overexpressed in
melasma. Br J Dermatol. 2005;154:1094-1099.
28. Çakmak SK, Özcan N, Kiliç A, Koparal S, Artüz F, Çakmak A,
et al. Etiopathogenetic factors, thyroid functions and thyroid
autoimmunity in melasma patients. Postepy Dermatol Alergol.
2015;32:327-330.
29. Handel AC, Miot LD, Miot HA. Melasma: a clinical and
epidemiological review. An Bras Dermatol. 2014;89(5):771-
782.
30. Serban ED, Farnetani F, Pellacani G, Constantin MM. Role of
In Vivo Reflectance Confocal Microscopy in the Analysis of
Melanocytic Lesions. Acta Dermatovenerol Croat. 2018;26(1):
64-67.
31. Agozzino M, Ferrari A, Cota C, Franceschini C, Buccini P,
Eibenshutz L, Ardigò M. Reflectance confocal microscopy
analysis of equivocal melanocytic lesions with severe regression.
Skin Res Technol. 2018;24(1):9-15.
32. Thangboonjit W, Limsaeng-u-rai S, Pluemsamran T, Panich U.
Comparative Evaluation of Antityrosinase and Antioxidant
Activities of Dietary Phenolics and their Activities in Melanoma
Cells Exposed to UVA. Siriraj Med J. 2014;66(1):5-10.
33. Noh S, Choi H, Kim JS, Kim IH, Mun JY. Study of hyperpigmentation
in human skin disorder using different electron microscopy
techniques. Microsc Res Tech. 2019;82(1):18-24.
34. El-Sinbawy ZG, Abdelnabi NM, Sarhan NE, Elgarhy LH.
Clinical & ultrastructural evaluation of the effect of fractional
CO2 laser on facial melasma. Ultrastruct Pathol. 2019;43(4-5):
135-144.
35. Viac J, Palacio S, Schmitt D, Claudy A. Expression of vascular
endothelial growth factor in normal epidermis, epithelial tumors
and cultured keratinocytes. Arch Dermatol Res. 1997;289(3):158-
163.
36. Rahmatullah WS, Al-Obaidi MT, AL-Saadi WI, Selman MO,
Faisal GG. Role of Vascular Endothelial Growth Factor (VEGF)
and Doppler Sub-endometrial Parameters as Predictors of
Successful Implantation in Intracytoplasmic Sperm Injection
(ICSI) Patients. Siriraj Med J. 2020;72:33-40.
37. Grimes PE, Yamada N, Bhawan J. Light microscopic,
immunohistochemical and ultrastructural alterations in patients
with melasma. A J Dermatopathol. 2005;27(2):96-101.
38. Yan QU, Wang F, Junru L, Xia X. Clinical observation and
dermoscopy evaluation of fractional CO2 laser combined with
topical tranexamic acid in melasma treatments. J Cosmet
Dermat. 2021;20(4):1110-1116.
39. Sarkar R, Ailawadi P, Garg S. Melasma in men: A review of
clinical, etiological, and management issues. J Clin Aesthet
Dermatol. 2018;11(2):53-59.
40. Hexsel D, Lacerda DA, Cavalcante AS, Machado Filho CA,
Kalil CL, Ayres EL, et al. Epidemiology of melasma in Brazilian
patients: a multicenter study. Int J Dermatol. 2014;53:440-444.
41. Kim HJ, Moon SH, Cho SH, Lee JD, Sung Kim H. Efficacy and
safety of Tranexamic acid in melasma: a meta-analysis and
systematic review. Acta Derm Venereol. 2017; 97(6-7):776-781.
42. Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. Risk
factors for facial melasma in women: A case-control study. Br
J Dermatol. 2014;171:588-594.
43. Nayaf MS, Ahmed AA, Abdalla MA. Alopecia Areata and
Serum Vitamin D in Iraqi Patients: A Case-Control Study.
Prensa Med Argent. 2020;106(3):287.
44. Gopichandani K, Arora P, Garga U, Bhardwaj M, Sharma N,
Gautam RK. Hormonal profile of melasma in Indian females.
Pigment Int. 2015;2:85-90.
45. Duteil L, Esdaile J, Maubert Y, Cathelineau AC, Bouloc A,
Queille-Roussel C, et al. A method to assess the protective
efficacy of sunscreens against visible light-induced pigmentation.
Photodermatol Photoimmunol Photomed. 2017;33(5):260-266.
46. Ching D, Amini E, Harvey NT, Wood BA, Mesbah Ardakani N.
Cutaneous tumoural melanosis: a presentation of complete
regression of cutaneous melanoma. Pathology. 2019;51(4):399-
404.
47. Abdalla MA, Nayaf MS, Hussein SZ. Correlation between serum
α-MSH and vitamin D levels in vitiligo patients. Iran J Dermatology.
2020;23(4):163-167.
48. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P,
et al. A global survey of the role of ultraviolet radiation and
hormonal influences in the development of melasma. J Eur
Acad Dermatol Venereol. 2009;23:1254-1262.
49. Goh CL, Chuah SY, Tien S, Thng G, Vitale MA, Delgado-Rubin
A. Double-blind, placebo-controlled trial to evaluate the
effectiveness of Polypodium leucotomos extract in the treatment
of melasma in Asian skin: A pilot study. J Clin Aesthet Dermatol.
2018;11(3):14-19.
50. Tamega Ade A, Miot HA, Moco NP, Silva MG, Marques ME,
Miot LD. Gene and protein expression of oestrogen-beta and
progesterone receptors in facial melasma and adjacent healthy
skin in women. Int J Cosmet Sci. 2015;37(2):222-228.
51. Niwano T, Terazawa S, Sato Y, Kato T, Nakajima H, Imokawa
G. Glucosamine abrogates the stem cell factor + endothelin-
1-induced stimulation of melanogenesis via a deficiency in
MITF expression due to the proteolytic degradation of CREB
in human melanocytes. Arch Dermatol Res. 2018;310:625-637.
52. Vâradi J, Harazin A, Fenyvesi F, Reti-Nagy K, Gogolâk P,
Vâmosi G, et al. Alpha- Melanocyte Stimulating Hormone
Protects against Cytokine-Induced Barrier Damage in Caco-2
Intestinal Epithelial Monolayers. PLOS ONE. 2017;12(1):e0170537.
53. Fearce CT, Swope V, Abdel-Malek Z. The Use of Analogs of
α-MSH as Tanning Agents for the Prevention of Melanoma.
FASEB J. 2016;30(1):1500-1509.
54. Saleh AA, Salam OHA, Metwally GH, Abdelsalam HA, Hassan
MA. Comparison Treatment of Vitiligo by Co-culture of
Melanocytes Derived from Hair Follicle with Adipose-Derived
Stem Cells with and without NB-UVB. Pigmentary Disorders.
2017;4:256.
55. Sarma N, Chakraborty S, Poojary SA, Rathi S, Kumaran S, Nirmal
B, et al. Evidence-based review, grade of recommendation,
and suggested treatment recommendations for melasma.
Indian Dermatol Online J. 2017;8(6):406-442.
56. Passeron T, Picardo M. Melasma, a photoaging disorder.
Pigment Cell Melanoma Res. 2018;1-5.
57. Kim SW, Yoon HS. Tamoxifen-induced melasma in a
postmenopausal woman. J Eur Acad Dermatol Venereol.
2009;23:1199-1200.
850 Volume 73, No.12: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/index
58. Rija FF, Hussein SZ, Abdalla MA. Physiological and Immunological
Disturbance in Rheumatoid Arthritis Patients. Baghdad Sci J.
2021;18(2):247-252. doi: 10.21123/bsj.2021.18.2.0247
59. Abdalla MA. Pneumatization patterns of human sphenoid sinus
associated with the internal carotid artery and optic nerve by CT
scan. Ro J Neurol. 2020;19(4):244-251. doi: 10.37897/RJN.2020.4.5.
60. Prabha N, Mahajan VK, Mehta KS, Chauhan PS, Gupta
M. Cosmetic Contact Sensitivity in Patients with Melasma:
Results of a Pilot Study. Dermatology Research and Practice.
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Published
01-12-2021
How to Cite
Abdalla, M. A. . (2021). Melasma Clinical Features, Diagnosis, Epidemiology and Etiology: An Update Review. Siriraj Medical Journal, 73(12), 841–850. https://doi.org/10.33192/Smj.2021.109
Issue
Section
Review Article
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