Melasma, Chloasma

Letztmals aufdatiert: 2021-04-03

Autor(en): Navarini

Melasma, Schwangerschaftsflecken, Chloasma

Hyperpigmentierung der Gesichtshaut, welche erworben vorkommt und klinisch eindeutig mit Sonennexposition assoziiert ist. Obschon im Winter eine Remission zu beobachten ist, kann das Melasma im Sommer rasch rezidivieren. 

Sehr häufig, insbesondere bei pigmentreichen Frauen im gebärfähigen Alter, viel weniger häufig bei Männern anzutreffen. Wichtigste Risikofaktoren sind Schwangerschaft und Einnahme von Kontrazeptiva. 

  • Melasma der Menarche
  • Melasma bei Kontrazeptiva-Einnahme
  • Melasma gravidarum
  • Melasma climactericum
  • Melasma hepaticum
  • Melasma cachecticorum
  • Melasma cosmeticum
  • Melasma medicamentosa (Antidepressiva, Finasterid)
  • Melasma traumaticum (bei Hitze / Kälte, denke an Erythema ab igne)
  • Melasma thyroidae bei Schilddrüsendysfunktion

Die Melaninsynthese ist durch die identifizierten Risikofaktoren positiv beeinflusst und führt zur Anreicherung von Pigmentmaterial. Es finden sich eine offensichtliche Rolle der Geschlechtshormone Östrogen und Progesteron. In den letzten Jahren wurde die Rolle von blauem Licht in den Vordergrund gestellt - es ist also nicht nur UV Licht, welches das Melasma induizieren kann. Dies ist sehr gut passend dazu, dass unserer Erfahrung nach intensiver Sonnenschutz mit Sonnencrème kaum eine gute Rezidivprophylaxe darstellt. 

Im Gesicht annähernd symmetrisch verteilte, klar hyperpigmentierte Maculae, von kleinfleckig bis grossfleckig-bizarr konfiguriert, nie infiltriert. 

Beim Melasma gravidarum finden sich auch Hyperpigmentierungen der Areolae, der Labia minora und der Linea alba. Diese wird dann Linea nigra genannt. 

Typische klinische Manifestation, Dermatoskopisches Muster, situative Anamnese. 

Stirne, bitemporal, Wangen, Oberlippe, weitere Regionen des Gesichts. 

Es finden sich einerseits Melanin-Anreicherungen im Str. basale bis unter das Str. corneum, andererseits auch eine Pigmentinkontinenz und damit Melanin-haltige Makrophagen in der oberen Dermix. 

Rezidiviert jedes Jahr gegen Sommer. 

Peeling und Pigmentlaser, Hydrochinon-Tretinoin-Dexamethason-Crème (Kligman). 

Prophylaxe mit Sonnencrème mit Blaulicht-Filter.

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