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Melasma

Ein Update zu Klinik, Therapie und Prävention

Melasma

An update on the clinical picture, treatment, and prevention

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Zusammenfassung

Als Melasma (Synonyme: Chloasma, Schwangerschaftsflecken) werden Hyperpigmentierungen bezeichnet, die als Folge einer erhöhten Synthese von Melanin meist in umschriebenen Arealen der Gesichtshaut entstehen. Aufgrund seiner hohen Inzidenz, den häufig stigmatisierenden Folgen und der eingeschränkten Wirksamkeit der aktuell zur Verfügung stehenden Therapieoptionen hat das Melasma gravierende Konsequenzen für die Lebensqualität betroffener Patienten/innen und stellt die behandelnden Ärzte vor große Herausforderungen. Obwohl neben Schwangerschaft und UV-Exposition zahlreiche weitere Risikofaktoren identifiziert werden konnten, ist die Pathogenese bislang noch weitestgehend ungeklärt, und die Therapie gestaltet sich oft sehr schwierig. Von entscheidender Bedeutung für den klinischen Verlauf ist ein konsequentes Meiden der UV-Exposition. Unter einem konsequenten Sonnenschutz sollte unbedingt auf eine ausreichende Vitamin-D-Versorgung geachtet werden, in der Regel ist eine orale Vitamin-D-Supplementierung erforderlich. Die etablierten Therapieoptionen, darunter die topische Anwendung von Depigmentierungsmitteln, führen häufig lediglich zu einer Besserung, aber nicht zur völligen Rückbildung der Hautveränderungen. Auch der Einsatz unterschiedlicher Lasersysteme führt oft nicht zum gewünschten Erfolg, hier sind durch die Entwicklung optimierter Therapiesysteme in den nächsten Jahren aber deutliche Verbesserungen zu erwarten. Diese Übersichtsarbeit fasst unseren aktuellen Kenntnisstand zu Klinik, Pathogenese und Therapie des Melasmas zusammen und gibt einen Ausblick auf zukünftige Entwicklungen.

Abstract

Melasma, also known as chloasma or mask of pregnancy, presents clinically as hyperpigmented skin areas, which develop mostly in the face as a consequence of increased synthesis of melanin. The established treatment options, including topically applied agents and the use of various laser systems, mostly result in improvement but not in complete remission of the lesions. Because of its significant impact on quality of life and the limited effectivity of available treatment options, the management of melasma is challenging for the treating physician. Although many risk factors, including pregnancy and UV exposure, have been identified, the pathogenesis is not yet fully understood. Avoiding solar or artificial UV exposure is of high importance both for the prevention of melasma and for the clinical outcome of existing lesions. In order to avoid vitamin D deficiency, oral vitamin D supplementation should be recommended. In this review, we give an update on clinical aspects, epidemiology, pathogenesis and therapy of melasma and give an outlook on future developments.

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Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland

    S. Becker, C. Schiekofer, T. Vogt & J. Reichrath

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  1. S. Becker
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  2. C. Schiekofer
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  3. T. Vogt
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  4. J. Reichrath
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Correspondence to S. Becker.

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S. Becker, C. Schiekofer, T. Vogt und J. Reichrath geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Becker, S., Schiekofer, C., Vogt, T. et al. Melasma. Hautarzt 68, 120–126 (2017). https://doi.org/10.1007/s00105-016-3927-7

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