Diagnostic criteria and classification of chloasmaClinical diagnostic criteria for chloasma1 facial light brown to dark brown circumscribed
Diagnostic criteria and classification of chloasma
Clinical diagnostic criteria for chloasma
1 facial light brown to dark brown circumscribed plaques, usually symmetrical, no inflammation and scaling;
2 no obvious symptoms;
3 mainly occurred in adolescence, female multiple;
The 4 condition has certain seasonal, Xia Dong light;
5 no obvious endocrine diseases, and other diseases caused by pigmentation.
(two) clinical classification of chloasma
1 according to the lesion site is divided into type 4
(1) butterfly type: the lesions were mainly distributed in the cheek, showing a symmetrical distribution of butterfly;
(2) the upper surface type: lesions mainly distributed in the forehead, temporal, nose and cheek;
(3) lower face type lesions are mainly distributed in the lower cheek, mouth and lips;
(4) pan type: skin lesions in the face of large areas.
2 according to the etiology is divided into type 2
(1) special hair: no incentive to be investigated;
(2) the following: due to pregnancy, menopause, oral contraceptives, sunlight and other reasons.
Three) efficacy criteria
Basic cure: (1) the naked eye visual pigment faded spot area is greater than 90%, the color disappeared; (2) score calculation, and decreased after the treatment index is more than 0.8;
Effect: (1) the naked eye visual pigment faded spot area is greater than 60%, the color became pale; (2) score calculation, and decreased after the treatment index is more than 0.5;
Improved: (1) the splash area subsided more than 30%, the color fades; (2) score calculation, and decreased after the treatment index less than or equal to 0.3;
Invalid: (1) the splash area of extinction is less than 30%, the color change is not obvious; (2) score calculation, and decreased after the treatment index is more than 0.3.
(four) scoring method
Skin lesion area score: 0 no skin lesions; area of < 2cm2; area of 2 ~ 4 cm2; area of skin lesions of >,; 4cm2; skin color score: 0 normal skin color; 1 light brown; brown, 3; dark brown of the 3 (2).
Total score = area score + color score. The method of calculating the decline index of the score: drop index = total score before treatment - total score after treatment.
Two, chloasma treatment
(I) treatment purposes
1 the lesion color returned to normal.
2 inhibit tyrosinase activity, melanin metabolism and transport.
(two) the main ways of treatment
1 melanocyte selective cytotoxic drugs;
2 inhibition of dopachrome tautomerase activity;
3 promote the absorption and metabolism of pigment;
Blood stasis in 4 Chinese herbal medicine;
5 free radical scavenging;
6 regulation of melanocyte and tyrosinase activity;
7 to prevent ultraviolet tanning;
8 biological agents.
(three) the main factors of treatment choice
The selection of treatment measures mainly considered the following factors: sex, age, course of disease, type, predisposing factors, concomitant diseases and so on.
(four) treatment rules
1 systemic therapy
Vitamin C and vitamin E: vitamin C can prevent the dopa oxidation mainly, inhibition of melanin synthesis; vitamin E reduced lipid peroxidation. The combination of the two effects is better than single use.
A three peptide compound that acts as an antioxidant enzyme or participates in enzymes that reduce the antioxidant effects of unsaturated fatty acids and free radicals. Inhibition of melanin formation by inhibiting tyrosinase activity. Oral or intravenous injection.
Tea polyphenols: tea polyphenols as tea extract, is a natural antioxidant, is the structure of hydroxyl hydrogen in the role of. Oral 0.2g, 3 times a day.
Pycnogenol: pine bark extract, its antioxidant than vitamin C and vitamin E, and vitamin C can promote the regeneration and recycling of vitamin E, enhance antioxidase system function, inhibition of ultraviolet radiation.
Ganoderma lucidum polysaccharide: improve immunity, enhance the body's ability to resist hypoxia, eliminate free radicals.
Hydroxy resveratrol: red grape skin extract, with the role of bleaching, anti-oxidation and so on.
Proanthocyanidins: grape seed extract, antioxidant effects of collagen, vitamin E, vitamin C 20 times.
Ligustrazine: the content of LPO in serum of patients with chloasma decreased, and the content of SOD in serum increased obviously. Ligustrazine Injection 160 mg was added into the glucose of 250 ml for intravenous drip, once a day for a period of 1 days for a course of treatment for a period of 15 days.
Freckle: active ingredients of Chinese medicine Fructus Corni, freckle on tyrosinase and melanin pigment have inhibitory effect is correlated to the degree of inhibition and concentration, the higher the concentration is, the stronger inhibitory effect.
2 topical treatment
Glycyrrhizin: it is a kind of oil soluble licorice extract, with the concentration of 0.1%, use 3 times a day, for a period of 4 weeks. Licorice extract made of cream, topical treatment chloasma, senile plaques were significantly improved.
Licorice flavonoids: natural whitening agent pure biological extraction of licorice, it has anti tyrosinase activity, inhibition of lipid peroxidation, inhibition of enzyme activity and antibacterial effect of dopachrome interconversion.
Retinoic acid: mainly through the regulation of melanocyte function, reduce the melanin into keratinocytes, and inhibit tyrosinase activity, reduce melanin formation.
Hydroquinone: mainly is blocked by tyrosine catalyzed from tyrosine to DOPA synthesis process, to influence the melanin, commonly used 2% ~ 3% hydroquinone cream, hydroquinone has certain irritation to the skin, and the relationship with concentration, higher concentration, the stronger irritation.
Azelaic acid: inhibit tyrosinase activity, reduce the formation of melanin, to remove pigmentation.
N- acetyl -4-s- cysteine phenol: a new depigmentation compound, with 4% N- acetyl -4-s- cysteamine treatment of chloasma, after a period of 2 to 4 weeks of local treatment can achieve significant results.
Arbutin: topical 3% arbutin cream or lotion, daily 2 times, effective rate of 71.4
Kojic acid: through inhibition of tyrosinase activity and inhibit the formation of melanin, can alone or in combination with retinoic acid, hydroxy acetic acid etc..
Fruit acid: accelerate skin replacement, low concentration can reduce the role of epidermal adhesion, high concentration can cause skin lysis, through the wound and skin re formation can remove pigmentation and skin damage. General use 10% concentration. L- ascorbic acid -2- phosphate magnesium (VC-PMG) 10%VC-PMG cream topical treatment of chloasma achieved good results.
Beta carotene, beta carotene can achieve the effect of speckle and the long-term use of stain gradually becomes shallow, two times a day to apply stain at.
3 traditional Chinese Medicine
(1) commonly used Xiaoyao Powder and Zhibai Dihuang Decoction, CHSGS, Rehmannia six, Yangxue Shugan pills etc.. The study found that six of Liuweidihuang Pill, Buzhongyiqi decoction, Jinkuishenqi pill, Taohong Siwu Decoction can reduce the activity of tyrosinase, the treatment effect on chloasma, and recommend the use of tuckahoe, yam, Cornus and fresh white skin, white atractylodes rhizome, dahurian angelica root compound preparation for treating chloasma is more effective.
(2) Chinese medicine Shuganlipi, Xiaoban huayu. Prescription: Rose, radix salviae miltiorrhizae, Radix Bupleuri, tangerine peel, angelica, Poria, Radix Paeoniae Alba, Radix Glycyrrhizae, seedcases.
4 physical therapy
Fractional photothermolysis (Fractional, FP): is a 1550 nm release of the laser beam through erbium, can be used to treat chloasma.
Er: YAG laser (Erbium): YAG laser at 2.94 nm wavelength, energy of 5.1 ~ 7.6J/cm2, is effective in the treatment of chloasma.
Strong pulse laser with Q switched ruby laser: the treatment of mixed pigmentation abnormalities observed during skin lesions first given pulsed laser treatment every 3 to 4 weeks at a time, and then the pulse after laser therapy or within a week for low energy Q switched ruby laser in the treatment of strong.
(1) sunscreen: chloasma occurs and increase the incidence of patients with sunlight accounted for 71.5% of the patients with vitiligo is very important.
(2) good mood: chloasma is associated with aggravating and emotional or fatigue accounted for 54.5% of patients to control their emotions, mood, work and rest should pay attention to problems in patients with chloasma.
(3) to ensure adequate sleep: sleep is a protective factor for melasma, with the extension of sleep time, the risk of melasma is gradually reduced.
(4) the protection of the right amount of soybean products as the chloasma.
(5) drug allergy and cosmetic allergy are the risk factors of chloasma, and it is more important for the patients with sensitive skin.
(6) risk factors for women with intrauterine contraceptive prevalence for chloasma, melasma patients used contraceptive methods should be paid more attention.