Hloazma — the focal hyperpegmentation of skin of various size which is settling down most often on a face and having a clear boundary. Hloazma has an appearance of a spot of light brown, brown or brownish color. Can have multiple character. The diagnosis is established on a typical clinical picture and localization of pigmentation, carry in addition out a siaskopiya, Dermoscopy, investigate a condition of a liver, the gynecologic sphere and bodies of a GIT. Treatment of a hloazma comes down to use of cosmetology ways of reduction of a saturation of its coloring. The peeling and bleaching means, a dermabraziya, a laser peeling, photorejuvenation, a mesotherapy and cryotherapy are applied.
In essence the hloazma is the acquired pigmentary spot. Its education is caused by excess adjournment of a pigment of melanin in the limited site of epidermis and located under it terms. Along with freckles, age pigmentation and secondary hyperpegmentations after the postponed burns and deep dermatitis, the hloazma belongs to the most met violations of pigmentation of skin. At women of a hloazm arises considerably more often than at men.
Causes of a hloazma
Today the dermatology cannot call the exact reasons of emergence of a hloazma. Most of researchers are inclined to consider that excess adjournment of melanin at a hloazma is caused by the endocrine and metabolic violations happening in an organism. This point of view is confirmed by frequent emergence at pregnant women, patients with chronic diseases of a liver (viral hepatitis B, chronic hepatitis, cirrhosis), the women having inflammatory processes of the gynecologic sphere (adneksit, salpingit, ooforit, an endometritis) or using medicines for oral contraception. Development of a hloazma can be promoted by excess impact on skin of sunshine or artificial sources of ultraviolet (for example, sunbed frequentation).
Manifestations of a hloazma
Hloazma represents the strengthened pigmentation of the limited site of skin. It has clear uneven boundary and does not tower over a surrounding integument. Coloring of a hloazma can fluctuate within various shades of brown color: light brown, yellowish, dark brown, brownish-brown. The size strongly varies. In one cases it makes no more than 1 cm in the diameter, in others — the hloazma can occupy the whole areas on a face.
The favourite arrangement is face skin: forehead, upper lip, nose bridge, cheeks, periorbitalny area. Skin and a chin, as a rule, is not affected a century. In more exceptional cases of a hloazma meet on the internal surface of hips, in the field of the average line of a stomach and on a breast. Pigmentation have the single isolated character more often, but can be multiple and at a close arrangement merge with each other, forming quite extensive pigmented zones. Emergence is not followed by an itch or morbidity. The esthetic and psychological discomfort is the only subjective feeling which the hloazma brings to the patient.
Separately allocate an okolorotovy hloazma of girls and a pigmentary okolorotovy dermatosis which are observed generally at female persons. These diseases are characterized by emergence around a mouth of symmetric brown spots. Typically long course, change of a saturation of pigmentation eventually and emergence of similar pigmentation on skin of nasolabial folds and a chin.
Also carry "the pigmentary line" to a hloazma - the diskhromiya having an appearance of the pigmented strip 10 mm wide going through a forehead and sometimes through a cheek of the neck reaching lateral face. This option of a hloazma often is the first sign of severe defeat of nervous system (a tumor of a brain, Parkinson's disease, a siringomiyeliya, meningovaskulyarny syphilis).
The "bronze hloazma" which received such name thanks to specific bronze coloring is widespread in camps of Asia. It occurs both at indigenous people, and at the Europeans living in Asia. When moving the last back gradual decrease in intensity of coloring of a hloazma and its spontaneous disappearance home is noted.
Diagnostics of a hloazma
For diagnostics of a hloazma it is enough to dermatologist to perform education inspection, at poll to exclude its congenital or post-inflammatory character. Siaskopiya and Dermoscopy allow to define prevalence and depth of a hloazma that matters for the choice of a method of treatment.
At identification of a hloazma a number of the additional inspections directed to a research of digestive tract and patient's liver is necessary. Biochemical tests of a liver, a koprogramm, the analysis on dysbacteriosis, gastroscopy, ultrasonography of abdominal organs and ultrasonography of a liver concern to them. Consultation of the gynecologist for an exception of diseases of the sexual sphere and selection of contraception is recommended to women.
Differential diagnostics of a hloazma is carried out with a professional melanodermiya, secondary hyperpegmentations, the Mongolian spot, a boundary pigmentary nevus, at especially big sizes of a hloazma — with a huge pigmentary nevus.
Treatment of a hloazma
From hloazma it is recommended to patients to avoid excessive ultra-violet radiation and to apply sun-protection funds from SPF 25-30. Correction of the existing exchange and hormonal violations is necessary. For the purpose of normalization of exchange of melanin appoint vitamin therapy: ascorbic and folic acid, Riboflavinum, group B vitamins.
It should be noted that specific methods of correction of pigmentary exchange or removal do not exist yet. In treatment generally cosmetology ways of reduction of intensity of pigmentation are applied. They have two directions: reduction of production of melanin in skin and peeling of a horn layer of epidermis in a pigmentation zone.
Reduction of a melaninoobrazovaniye is promoted by the following groups of substances: inhibitors tyrosineelements (koyevy acid, ); inhibitors of synthesis of a pigment in melanotsita (azelainovy acid, hydrochinone); vitamin C derivatives. The majority of these substances are toxic, especially hydrochinone. However their application continues as gives noticeable effect. The specified means are a part of various bleaching creams and ointments. Sulfuric ointments and white sedimentary mercury also possess the bleaching action.
Treat the peeling means: lemon and lactic acid, alpha hydroxyacids, glikoliyevy acid. These substances are used for carrying out a chemical peeling. At a hloazma TSA and an ANA-peeling is applied glikoliyevy, phenolic. Hardware methods give good effect: dermabraziya, laser peeling, cryotherapy. Elimination of a hloazma, as well as other pigmentation, is promoted by photorejuvenation, laser cosmetology, cryomassage, a mesotherapy the bleaching cocktails. Biorevitalization of skin with use of hyaluronic acid leads to normalization of exchange processes of skin including pigmentary. However all hloazma used in treatment methods demand numerous and complex application.
At a hloazma of pregnant women it is better not to carry out treatment as during this period there is a mass of contraindications, and after the delivery such hloazma usually passes independently.