A 36 years old female patient attends the OG department and complains of dark spots in face over the past few years. She initially noticed it after her first child birth, five years earlier. The lesions become worse in the second pregnancy, two years back. She does not have any other medical problems. She was not on any drugs except for oral contraceptive pills. She does not appear to be stressed. Blood pressure- 120/76 mmHg, Pulse rate- 84/min, temperature- 37.6 C, Respiratory rate-16/ min. On her forehead, cheeks and chin, multiple, discrete confluent well demarcated patches of brown hypopigmentation are seen. Complete blood count ant thyroid profile tests are normal. The most appropriate advice is -
Answer: c) Melasma may or may not return with each subsequent pregnancyMELASMAMelasma (Greek: "a black spot") is an acquired light- or dark-brown hyperpigmentation that occurs in the exposed areas, most often on the face, and results from exposure to sunlight.It may be associated with pregnancy, with ingestion of contraceptive hormones, or possibly with certain medications such as diphenylhydantoin or it may be idiopathic.Females > males; about 10% of patients with melasma are men.Common, especially among persons with constitutive brown skin color who are taking contraceptive regimens and who live in sunny areas.Pregnancy causes melasma.Melasma has recently been appearing in menopausal women as a result of regimens for prevention of osteoporosis using a combination of estrogens and progesterone;The pigmentation usually evolves quite rapidly over weeks, particularly after exposure to sunlight.Completely macular hyperpigmentation of the face, the hue and intensity depending largely on the skin phototype of the patientMost often symmetric.Lesions have serrated, irregular and geographic borders.Two-thirds on the central part of the face: cheeks, forehead, nose, upper lip, and chin; a smaller percentage on the malar or mandibular areas of the face and occasionally the dorsa of the forearms.May disappear spontaneously over a period of months after delivery or after cessation of contraceptive hormones.Melasma may or may not return with each subsequent pregnancy.Treatment with hydroquinone can lead to a permanent loss of melanocytes with the development of a disfiguring spotty leukoderma.Prevention: opaque sunblock containing titanium dioxide and/or zinc oxide.Even the potent transparent sunscreens (with high SPF) are completely ineffective in blocking visible radiation
Use of oral contraceptive pills not likely to influence it
It is a sign of underlying endocrine disease
Melasma may or may not return with each subsequent pregnancy
Persists for life time.