Revista de Dermatologia e Doenças Dermatológicas

Melasma is a common acquired hypermelanosis that affects sun-exposed areas of the skin, especially the face. Its histologic manifestations are evident in the epidermis, extracellular matrix, and dermis. One of the hallmarks of melasma is an increase in the amount of epidermal melanin; however, whether melanocyte numbers increase or not is a topic of debate. Interestingly, basement membrane abnormalities also characterize melasma. Furthermore, solar elastosis is recognized as one of the dermal pathologic findings of melasma. These findings suggest that extracellular matrix abnormalities are consistently found in melasma. In the dermis, increased vascularity and increases in mast cell numbers are observed, indicating that dermal factors have important roles in the pathogenesis of melasma, despite melasma being characterized by epidermal hyperpigmentation. This review discusses these histologic characteristics of melasma, and it considers their implications for the pathogenesis of this skin condition.

Background: Melasma is a frequently encountered hypermelanoses that affects large number of men and women worldwide. Traditionally, three clinical patterns have been described: Malar, Centrofacial, and Mandibular. Involvement of superciliary region has not been described in any of the patterns; however, it is seen in a significant number of patients. Objective: To observe for presence of pigmentation at superciliary regions in patients suffering from melasma. Methods: Patients with previously untreated melasma attending dermatology out-patient department at our hospital were observed for superciliary pigmentation. Short history pertaining to pigmentation and duration was taken. Clinical patterns of melasma and depth of pigmentation (on wood’s lamp) were noted. Precipitating factors were enquired for and noted if present. Results: Total 82 melasma patients were analysed out of which 36 patients (43.90%) were found to have pigmentation at the superciliary region. Potential precipitating factors seen overall were: sun exposure – 18 (21.95%), pregnancy – 13 (15.86%) and oral contraceptive pills – 8 (9.76%). Among 21 patients who had either pregnancy or contraceptive pills as precipitating factors, 16 had superciliary pigmentation. This increased proportion of hormonal precipitating factors (pregnancy and oral contraceptive pills) seen in superciliary subset was statistically significant (44.44% in superciliary subset vs 25.6% overall, p=0.0423). Conclusion: Superciliary pigmentation is seen in a substantial proportion of melasma patients in our setup. Difference in incidence of hormonal precipitating factors (pregnancy, oral contraceptive pills) among patients with superciliary involvement points towards influence of hormonal factors on pigmentation at this site. Also, cultural factors like veil wearing habits of women in this region may influence superciliary pigmentation. Further studies are required to ascertain the significance and mechanisms of pigmentation at this site.

Melanoma remains a major cause of morbidity and mortality worldwide, however tremendous advances have been made in its treatment over the past several years. The discovery of genomic alterations that contribute to oncogenicity has ushered in a new era of molecularly-targeted therapy. Importantly, over half of melanomas harbor a mutation in the BRAF gene that leads to constitutive signaling down the MAPK pathway and multiple subsequent deleterious effects. Pharmacologic agents targeting this mutation have been developed and several are now FDA-approved, having yielded high response rates to therapy although these are tempered by a short duration of response. Multiple molecular mechanisms of resistance have been identified; however until recently few studies had delved into the immune effects of BRAF inhibitors. The effect of BRAF inhibition on anti-tumor immunity will be discussed herein, as will potential implications of these findings in the treatment of melanoma.

Melanoma remains a major cause of morbidity and mortality worldwide, however tremendous advances have been made in its treatment over the past several years. The discovery of genomic alterations that contribute to oncogenicity has ushered in a new era of molecularly-targeted therapy. Importantly, over half of melanomas harbor a mutation in the BRAF gene that leads to constitutive signaling down the MAPK pathway and multiple subsequent deleterious effects. Pharmacologic agents targeting this mutation have been developed and several are now FDA-approved, having yielded high response rates to therapy although these are tempered by a short duration of response. Multiple molecular mechanisms of resistance have been identified; however until recently few studies had delved into the immune effects of BRAF inhibitors. The effect of BRAF inhibition on anti-tumor immunity will be discussed herein, as will potential implications of these findings in the treatment of melanoma.

Throughout a females’ life, scalp hair growth is variable in its extent and time course. Age-related changes can occur to it including changes in the hair cycling, hair density, hair diameter and pigmentation, and possibly in structural qualities of the hair fiber. Evidence is starting to appear that environmental factors also contribute, possibly in a major way, to the changes that we observe in scalp hair growth as women get older. These changes are most pronounced in female pattern hair loss. Determining the cause or causes of hair loss in women can be difficult and should be guided by the patient’s history, including, the pattern of hair loss, other medical conditions, the use of hair treatments, and the family history as well as by the physical examination to differentiate between female pattern hair loss (FPHL) and telogen effluvium (TE). Topical anti-aging compounds include photoprotectors and antioxidants. In the absence of another way to reverse hair graying, hair colorants remain the mainstay of recovering lost hair color. Topical liposome targeting for melanins, genes, and proteins selectively to hair follicles are currently under investigation.

Nail pigmentations can exhibit many different colors and shades. Most of them are harmless but cosmetically embarrassing, others are potentially serious and may lead to death if not adequately diagnosed and treated. This short review gives an explanation for a number of nail dyschromias and their etiologies as well as some hints as to their treatment.

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