How To Cure Melasma From The Inside

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How To Cure Melasma From The Inside
Other Treatments – Since the causes of melasma are complex and unclear, the problem can be difficult to treat. While improving internal factors can help, many people benefit from a combination of therapies. Your healthcare provider may advise adding one or more of the following topical melasma therapies to your treatment plan:

  • A broad-spectrum sunscreen and reduction of sun exposure
  • Hydroquinone
  • Tretinoin and a mild corticosteroid
  • Triple combination cream (tretinoin, corticosteroid, and hydroquinone)
  • Azelaic acid, kojic acid, or vitamin C

When melasma is stubborn, or you want to promote faster results, your healthcare provider may advise using one of the following procedures:

  • Chemical peel
  • Microneedling
  • Laser treatments
  • LED light treatments
  • Platelet-rich plasma (PRP)

Cases of extremely stubborn melasma may improve with tranexamic acid, a medication given in topical or pill form.

Can you heal melasma internally?

Can melasma be treated? – Currently there is no cure for melasma; however, there are several medications and procedures available to manage this condition. It is important to know that these treatment options may result in an incomplete response, meaning that some of the discolorations become lighter or disappear while some remain unchanged.

How I healed my melasma naturally?

6 completely natural ways to cure acute melasma – Blog What is melasma? Melasma is a skin disorder where your skin becomes brown and patchy. It most commonly appears on your cheeks, bridge of your nose, forehead, chin, or above your upper lip. It may also appear on the other parts of your body that are exposed to sunlight.

  • Apply sunscreen 20 minutes before stepping out.
  • Wear full sleeved tops and pants. Also, consider wearing a hat.
  • You could try to apply two layers of SPF infused sunscreen. Apply a layer of SPF 15 and SPF 30 for double protection.
  • If stress and hormonal imbalance are the reason behind melasma, try to make time for activities that help you relax, like walking or yoga.
  • Use skin lightening lotions that contain Kojic acid or melaplex. These ingredients slow down the production of skin darkening and make it difficult for melasma to set in.
  • Chemical peels are also a great way of lightening melasma. Thanks to the glycolic acid that’s available in a chemical peel, the first layer of skin that contains melasma will be peeled off.
  • Another option is laser treatments. However, if you decide to opt for one, go for a restorative or fractional dual laser. These lasers only target pigmentation that’s on the surface of the skin.

Tips for melasma treatment at home If you’re not okay with chemicals, then you can always go for natural treatment for melasma. Below are few common ways to do so.

  1. Turmeric Turmeric contains curcumin, a strong antioxidant that results in lighter skin. Using a 1:2 ratio, mix milk with turmeric powder and apply the mixture on the affected areas. Let the pack dry completely and then rinse it with lukewarm water. Repeat this procedure every day for best results.
  2. Lemon Lemon is one of the most popular natural remedies for skin related disorders. Lemon is also known as a natural bleaching agent. All you have to do is apply lemon juice on the affected areas and leave it on for about 20 minutes. Wash it off with lukewarm water. Do this twice a day and you will see a noticeable difference in 3 weeks.
  3. Papaya Both raw and ripe papaya are used for curing various skin disorders. Papain, present in papayas, causes them to be the best home remedy for melasma. Mash a few pieces of papaya and mix it with honey. Apply the paste on affected areas and leave it for 20 minutes. Wash this pack off after 20 minutes. Do this once a week and for about 2-3 months.
  4. Aloe vera Aloe vera is an ingredient used in many face related products. It’s always best to use fresh aloe vera. Apply the gel, fresh off the plant, twice a day and massage your face for roughly two minutes. Leave it on for 15 minutes and wash off with lukewarm water.
  5. Onion There are a lot of home remedies for melisma, and onion juice is one of the best amongst them. Because onion contains sulfoxides and cepaenes, it helps in getting rid of melasma while also removing the blemishes. Mash the onion and mix it with apple cider vinegar, use a cotton ball and dab it all over the affected areas. After about 20 minutes, wash it off with lukewarm water. Repeat this twice a day for better results.
  6. Cucumber Cucumber is another home remedy that can be used for removal of pigmentation. Because cucumber is high in water content it lightens the pigmented skin. You simply have to grate the cucumber and apply it on affected areas. Wash it off with warm water after 20 minutes. Repeat this process once every day for best results.

Kaya’s treatment for melasma Kaya products are natural and reliable. Below are few things you can do with Kaya’s products to help treat melasma:

  • Kaya’s Daily Moisturizing Sunscreen: Use Kaya’s Daily Moisturizing sunscreen before you step out. It contains SPF 30 that has both UVB and UVA protection. This lotion is grease free and absorbs into your skin well. Kaya’s Daily Moisturizing Sunscreen is suitable for all skin types and can be used every day.
  • Kaya’s Youth Protect Sunscreen: Kaya’s Youth Protect Sunscreen comes with SPF 50 and ensures highest UVB and UVA protection. This product is PABA free, non-greasy, and suitable for all skin types.
  • Kaya’s Pigmentation Reducing Complex: This cream reduces pigmentation marks and spots from your skin. It contains Azeloyl Diglycinate, Glyceryl Stearate, PEG-100 Stearate and Trimethyl Phenyl Silsesquioxane that prevents further darkening of the skin. The lotion absorbs really well into the skin and can be used for all skin types.
  • Kaya’s Intense Clarity Peel: This is a unique peel that combines derma peels and botanical actives. These peels will naturally reduce the pigmentation and lighten the skin. It’s suitable for all skin types and you’ll see visible results in about 6 sessions.
  • Kaya’s Insta Clarity Laser: This is Kaya’s latest technology that aims to reduce your pigmentation spots and marks. Kaya uses a Q-Switched laser that considered very safe for Indian skin. It’s an invisible beam that targets brown marks on the skin. The best part is you can return to your daily activities without any hassle. It’ll take about 6-8 sessions to see results.

For melasma, there are both, scientific and natural procedures that can be used for treatment. Kaya is a combination of both, offering scientifically proven products rooted in natural formulae to revive and rejuvenate your skin. : 6 completely natural ways to cure acute melasma – Blog

What internally causes melasma?

Pregnancy: An increase in the hormones estrogen and progesterone, which occurs during pregnancy, is thought to trigger melasma. Some medications: The following medications may trigger melasma in some people: Anti-seizure medications. Birth control pills (also known as oral contraceptive pills)

What vitamins help melasma?

How to Prevent Melasma – Limit sun exposure and apply sunscreen daily to prevent or avoid melasma worsening. Try to reduce your stress levels because stress raises cortisol levels, which can worsen melasma. To do so, sleep 7-8 hours every day and try meditation.

  • Inflammation promotes pigmentation.
  • Antioxidant and anti-inflammatory vitamins assist in preventing melasma by counteracting its effects.
  • Antioxidants also help repair UV damage that causes melasma.
  • Therefore, eat as many vitamins and antioxidant-rich things as possible, particularly foods high in vitamin C and E like citrus fruits, kiwis, pistachios, almonds, flaxseeds, colorful vegetables and fish (especially salmon).

In addition, eat foods high in folate because a folic acid deficiency can lead to melasma. Foods high in folate include citrus fruits, green leafy vegetables, nuts and whole grains. You may also need to adjust your copper intake. This is because copper causes extra skin pigmentation by promoting melanin production.

What vitamin deficiency causes melasma?

What deficiency causes melasma? – Studies have proved that there is a link between vitamin B12 deficiency and melasma, which means a deficiency of vitamin B12 can cause melasma on the face. Iron deficiency anemia can also lead to melasma. Some believe that the deficiency of vitamin D could cause melasma but there are no reports of vitamin D deficiency being associated with this skin condition.

Which fruits cure melasma?

2. What is the process of building a diet to treat melasma and freckles? – Can diet affect the skin and affect the appearance of melasma and freckles? These are questions that many people with hyperpigmentation ask. The answer is yes. For a good reason, the skin is considered the largest organ in the body – it covers all the rest.

When ingested, a large amount of nutrients will be nourished skin cells. This means that if you put foods low in nutrients into your body, your skin will receive a low source of nutrients to grow and repair. Likewise, nutrient-rich foods rich in vitamins, zinc, calcium, magnesium, and manganese will provide the skin with high-quality energy to function.

So diet plays an important role in overall skin health. A healthy diet for glowing skin is a diet that is full of nutrients that are beneficial for the skin. Beautiful skin must be made up of healthy, elastic and vibrant skin cells when supplied with a constant supply of high-quality nutrients.

  1. If you maintain a diet lacking in nutrients, your skin cells will soon starve and begin to look dull, old, and lifeless.
  2. Some of the best foods for glowing skin are green vegetables, fatty fish like salmon, strawberries, broccoli, and citrus fruits rich in vitamin C.
  3. When the skin suffers from hyperpigmentation problems such as melasma, freckles, sun spots and hyperpigmentation, diet can play a role in the treatment.

One cause of hyperpigmentation in most cases is cellular stress. When skin cells are under stress from exposure, hormonal imbalances and infections, following a healthy skin diet can help reduce the effects of these factors. Chế độ ăn dinh dưỡng cao giúp điều trị nám và tàn nhang Step 1 Consult a dermatologist about melasma and freckles. Your doctor may order blood tests to check for nutritional deficiencies and poor liver function that may be causing this condition. Besides, melasma can also be a side effect of a drug being taken.

  • Ask your doctor to confirm or rule this out.
  • Step 2 Choose foods rich in folate because melasma can also be caused by folate or folic acid deficiency.
  • Low levels of this B vitamin can occur in women who are pregnant or have an inadequate diet.
  • Citrus fruits, green vegetables, and whole grains are good choices for folate or folic acid supplements.

Your doctor may also prescribe folic acid supplements. Step 3 Balance the amount of copper mineral in the diet. High levels of this mineral can be indicated in melasma. Copper promotes melanin production in the skin and high levels can cause excess pigmentation.

If you are taking a multivitamin that contains copper, do not take this mineral alone. Do not take more than the recommended daily intake of 900 mcg copper for adults, 1,000 mcg for pregnant women, and 1,300 mcg for nursing mothers. To reduce excess copper, eat foods high in vitamin C and iron or take a supplement with these nutrients.

Step 4 Increase your consumption of foods rich in vitamins C and E. These antioxidant nutrients help repair sun damage to the skin that can cause melasma. These vitamins are found in foods like citrus fruits, kiwis, nuts, almonds, brightly colored vegetables, and in fish. Trái cây họ cam quýt giúp giảm nám và tàn nhang

Why wont my melasma go away?

Treatment – Most people with melasma do not need treatment. Melasma may fade away slowly if you stop taking birth control pills or hormone replacement therapy. If melasma appeared while you were pregnant, it may go away a few months after you have the baby.

Is melasma related to liver?

Risk Factors for Developing Melasma –

Sunlight is the greatest risk factor, resulting from exposure to UVA, UVB and Visible light. Hormonal lead to the production of more melanin pigment, whether through pregnancy, menopause, oral contraceptives, or cosmetics containing hormones. Genetics play a role in about 50% of cases of people affected by melasma. Malnutrition may be a contributing factors because melasma is often found in people with abnormal liver function and vitamin B12 deficiency. Cosmetics containing hydroquinone may cause dark patches, like melasma.

The above are the risk factors for developing melasma. Generally, shallow pigmentation can happen easily and locate the outer layer of skin so it is easier to treat than deep pigmentation. Try to avoid the risk factors to reduce the risk of developing the condition and reduce the risk of melasma reappearing after fading.

Is melasma cancerous?

No, melasma is not a type of cancer. It’s also not a sign of skin cancer. Melasma differs from skin cancer in that it typically feels flat and appears on both sides of your face.

Can b12 deficiency cause melasma?

Authors: Azadeh Goodarzi, Elham Behrangi, Afsaneh Sadeghzadeh-Bazargan, Masoumeh Roohaninasab, Fatemeh Sadat Hosseini-Baharanchi, Mahsa Shemshadi, Elham Vafaei Abstract: Background — Melasma is a chronic acquired localized hypermelanosis, causing aesthetic problem for women and impairing their quality of life.

Evidence has suggested that hyperpigmentation can occur as a result of iron deficiency anemia and vitamin B12 deficiency. Aim — We aimed to evaluate the serum parameters of iron profile in melasma patients. Material and Methods — This case-control study investigated 51 adult non pregnant women with melasma, compared with 51 controls, from patients referred to the Hospital, Tehran, Iran, 2017–2018.

Melasma was diagnosed clinically according to the melasma area and severity index (MASI) score was calculated and recorded by the physician. The groups were compared in terms of vitamin B12, folate, serum iron, hemoglobin (Hb), mean corpuscular volume (MCV), total iron binding capacity (TIBC), and ferritin.

Results — The mean and standard deviation of the women’s age was 36.89±8.88 years, significantly higher in the group of patients with melasma. Comparing the serum parameters between the groups indicated no statistically significant difference in terms of mean levels of ferritin, Hb, MCV, iron, vitamin B12, TIBC, and folate.

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The women in melasma group had a higher frequency in below normal range of ferritin and serum iron compared to the control group. None of the serum parameters were correlated with MASI. Conclusion — The higher frequency of below normal range of ferritin and serum iron levels in women with melasma compared to the control group showed a possible association between these serum parameters and melasma.

  • Cite as: Goodarzi A, Behrangi E, Bazargan AS, Roohaninasab M, Hosseini-Baharanchi FS, Shemshadi M, Vafaei E.
  • The association between melasma and iron profile: a case-control study.
  • Russian Open Medical Journal 2020; 9: e0202.
  • Introduction Melasma is a chronic acquired disease of the skin, caused by melanogenesis dysfunction, resulting in localized hypermelanosis,

Although medically considered a benign lesion, the aesthetic complication of melasma can impair women’s quality of life and raise psychological concerns in the affected patients, As to the evidence, melasma occurs in all races, ethnic populations, and geographic areas; however, the incidence of melasma in the generalpopulation is not clear and most studies describe the prevalence only according to the dermatologic visits,

Generally, a higher prevalence is reported in populations with a darker skin phenotypes (Fitzpatrick III and IV), including Hispanic and Latin Americans, Asians, Middle Eastern and Africans and a prevalence of about 40% is reported in Iranian women, Although the exact pathogenesis of melasma is uncertain, a combination of genetic predisposition, in addition to environmental factors, like sun exposure, have been suggested to play a role in its higher incidence in summer on exposed parts of the body,

The higher incidence in women, especially during pregnancy, is also attributed to the role of female hormones on occurrence of melasma, Hence, as melasma requires long–term treatment and the exact etiology is still unclear, research has focused on the underlying and attributing factors in order to take a step towards a better understanding of the disease.

In this regard, several serum parameters, like zinc, iron, copper, and magnesium, have been associated with skin lesions and melasma, Vitamin B 12 deficiency is also associated with hyperpigmentation and vitiligo, However, its association with melasma is doubted, Iron deficiency anemia is a public health problem with the highest prevalence in women of reproductive age the same population susceptible for melasma.

Evidence has suggested that hyper pigmentation can occur as a result of iron deficiency anemia and patients with melasma have been reported to have a lower serum levels of hemoglobin (Hb), iron, ferritin and total iron binding capacity (TIBC), Hence, these studies had several limitations, such as limited sample size and not controlling the effect of confounders, like endocrine disorders and using medications like oral contraceptives, which could affect the results.

  • Therefore, for a definite conclusion, we aimed to compare the serum levels of vitamin B 12, folate, serum iron, Hb, mean corpuscular volume (MCV), TIBC, and ferritin between nonpregnant women with and without melasma controlling for confounders.
  • Material and Methods Study sample The present case-control study investigated women with melasma who referred to the Dermatology Ward of the Rasoul Akram Hospital, Tehran, Iran, during 2017–2018.

The sample size was calculated at 51 in each group based on the mean serum iron level of the study by Qazi and colleagues, considering type I and II error of 0.05 and 0.20, respectively. Accordingly, a total of 102 women were investigated in two groups: 51 patients in the case group and 51 patients in the control group.

The inclusion criteria for both groups consisted of adult non–pregnant women aged 20 to 50 years old, with normal body mass index (BMI) (18.5–25 kg/m2), without autoimmune, thyroid or cardiac disease, pernicious anemia, celiac disease, Crohn’s disease, leukemia, or cancer, and without history of hormone replacement therapy, alcohol use, smoking, oral contraceptive pills (OCP), phototoxic drugs, phenytoin, spironolactone, vitamin B12, and folic acid during last six months, who referred to the selected hospital’s ward during the study period.

Furthermore, the participants without vegetarian habit were included. The participants of the case group were selected from patients with melasma by convenient sampling method from who referred to the Dermatology Ward of the hospital and participants of the control group were selected from patients who referred to other wards of the hospital, rather than dermatology, who were included by matching each control with each case.

Patients were included into the study, after the researcher explained the study objectives and methods to the participants and asked them to read and sign the written informed consent, if they desired to participate in the study. They were ensured that all their information will be kept confidential and analyzed without revealing their personal information.

Melasma diagnosis For the case group, all patients were visited by the clinic’s physician and diagnosis of melasma was made clinically, by wood lamp, after ruling out other dermatologic/inflammatory disorders, Also, themelasma area and severity index (MASI) score was calculated by the physician and recorded in the study checklist.

  • Variables For measurement of vitamin B12, folate, serum iron, Hb, MCV, TIBC, and ferritin, 15 cc venous blood sample was taken from participants of both groups, kept in refrigerator, and sent to the hospital’s laboratory immediately.
  • Normal range of the serum parameters, the laboratory measurement techniques, and devices used are shown in Table 1.

Table 1. Comparing serum measurements between melasma and control groups adjusted for age in linear regression

Variant Normal range, laboratory measurement method and device name Melasma Control P–value
Ferritin, ng/ml 10–90, BT 3000 35.11±38.13 36.73±24.68 0.274
Hemoglobin, g/dl 12–16, Full diff Sismex 13.05±0.98 13.07±0.79 0.986
MCV, fl 77–97 femtoliter 86.93±4.95 84.88±5.61 0.589
Serum iron, micg/dl 40–155, Full diff Sismex 65.90±31.90 61.72±24.39 0.403
TIBC, micg/dl 230–440, BT 3000 337.47±49.12 316±49.44 0.055
Vitamin B 12, pg/ml 211–946, electrochemiluminescence, (ECL, made in Germany, 2010) 341.45±212.56 374±146.56 0.491
Folate, ng/ml 4.6–34.8, electrochemiluminescence, (ECL, made in Germany, 2010) 11.01±6.25 13.13±6.04 0.058

Data presented as mean with standard deviation – M±SD. Statistical analysis Numbers with percentage and mean with standard deviation (M±SD) were used to describe qualitative and quantitative variables, respectively. Independent sample t–test was used to compare the quantitative variables with normal distribution. Kolmogorov-Smirnov test was used to investigate normality assumption. The comparison of the serum parameters between groups adjusted for significant covariates were done using multiple linear regression and logistic regression. Pearson’s correlation coefficient was calculated to evaluate the association between the MASI scores and the serum parameters. The statistical software IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp. Released 2013. Armonk, NY: IBM Corp), was used for statistical analysis. P-value less than 0.05 were considered significant. Results This study was completed by 51 women in the case group (with melasma) and 51 women without melasma (as the control group). The mean ±SD of the women’s age was 36.89±8.88 years. Table 2 shows that the characteristics of the women in melasma and control group were homogenous (P>0.05) except women’s mean age which had a statistically significant difference between case and control groups (41.45±6.18 vs.32.33±8.86, respectively) (P 0.5). Table 2. Comparison the characteristics of the women in melasma and control group

P–value Control Melasma Characteristic
<0.001 32.33±8.86 41.45±6.18 Age, year, M±SD
0.074 Family history of melasma
20 (39) 29 (57) Yes
31 (61) 22 (43) No
0.192 Using sunscreen, n (%)
19 (37) 29 (57) Yes
32 (63) 22 (43) No
0.685 Employment, n (%)
30 (59) 32 (63) housewife
21 (41) 19 (37) Employed
0.308 Marital status, n (%)
50 (98) 48 (94) Married
1 (1) 3 (6) Single
0.295 Duration expose to sun (hour), n (%)
16 (32) 10 (19) <1
30 (60) 34 (67) 1-2
4 (8) 7 (14) >2

M±SD – data presented as mean with standard deviation; n (%) – data presented as numbers and percentages. The patients’ serum parameters are compared between the groups in Table 2. As indicated, there was no statistically significant difference between the groups in mean serum levels offerritin, Hb, MCV, iron, vitamin B 12, TIBC, and folate adjusted for female age (P>0.05). The serum parameters were categorized based on the normal range of each serum parameter and compared between the groups as shown in Table 3. It was showed that the odds of melasma for the female with below normal range of ferritin level (<10) was 4.07 (1.2, 13.8) than the odds of melasma for the female with normal ferritin level (P=0.023). The female with below normal range of iron level had the risk of melasma 3.99 (1.04, 15.25) than the female with normal iron level (P=0.042). In addition, below normal range level of MCV decreased risk of female's melasma, however, it was not statistically significant ( Table 3, P=0.814). It was observed that the risk of melasma was higher in females with below normal range level of HB (P=0.79), Vitamin B12 (P=0.058), and folate (P=0.158) in comparison to the females with that of in normal range. It was observed that the risk of melasma was lower in females with below normal range level of TIBC (P=0.814) and MCV (P=0.8) in comparison to the females with that of in normal range. Table 3. Odds Ratio (95% confidence interval (CI)) for each serum parameter between the case and control groups adjusted for age

Serum parameter Categories Melasma Control Odds Ratio (95% CI) P-value
Ferritin, ng/ml <10 17(33) 5(9.8) 4.07 (1.2, 13.8) 0.023
10–90 * 29(56.9) 44(86.3) 1
>90 5(9.8) 2(3.9) 0.93 (0.11, 7.53) 0.940
Hemoglobin, g/dl <12 5(9.8) 5(9.8) 1.22 (0.27, 5.63) 0.791
>12 46(90.2) 46(90.2) 1
MCV, fl <77 1(2) 3(5.9) 0.73 (0.06, 8.5) 0.800
77–97 * 49(96.1) 48(94.1) 1
>97 1(2) 0(0)
Iron, micg/dl <40 11(21.6) 5(9.8) 3.99 (1.04, 15.25) 0.042
40–155 * 39(76.5) 46(90.2) 1
>155 1(2) 0(0)
TIBC, micg/dl <230 1(2) 2(3.9) 1.4 (0.09, 21.8) 0.814
230–440* 49(96.1) 49(96.1) 1
>440 1(2) 0(0)
Vitamin B 12, pg/ml <211 13(25.5) 5(9.8) 3.47 (0.95, 12.6) 0.058
211–946* 36(70.6) 46(90.2) 1
>946 2(3.9) 0(0)
Folate, ng/ml <4.6 4(7.8) 1(2) 5.7 (0.51, 63.1) 0.158
4.6–34.8* 47(92.2) 50(98) 1
>34.8 0(0) 0(0)

Normal range was considered as the reference group, † Significant difference, in the case of zero frequency, the associated cell is omitted in the logistic regression modelling. Table 4 shows the assessment of the correlation between MASI and serum parameters in which none of the serum parameters were significantly associated with MASI (P>0.05). Table 4. The Pearson’s correlation coefficient between the MASI score and the serum parameters

Variant Correlation P-value
Ferritin -0.11 0.45
Hemoglobin -0.10 0.48
MCV 0.20 0.15
Iron 0.03 0.81
TIBC -0.15 0.29
Vitamin B 12 0.16 0.24
Folate -0.03 0.83

Discussion This study showed a higher frequency of below normal range ferritin level and serum iron levels in women with melasma, compared to the control group. Risk of melasma for the female with below normal range of ferritin level as well as iron was significantly higher than that of the patients with normal level which could imply the role of these serum parameters on melasma.

  1. According to the evidence, hyperpigmentation is a symptom of vitamin B 12 deficiency, presenting prior to neurologic symptoms,
  2. Vitamin B 12 is an important cofactor for methionine synthaseand its deficiency results in impaired methylation and DNA synthesis of haemoglobin and accumulation of homocysteine,

In melanogenesis, hyperpigmentation occurs due to depletion of intracellular glutathione, which inhibited tyrosinase activity, Babaie and colleagues tested the serum level of vitamin B 12 in melasma and reported that only 1/70 had a deficient vitamin B 12 level, while in the present study 13/51 women (25.5%) had a deficient vitamin B 12 level.

  • This discrepancy between the results of the studies can be due to the different inclusion and exclusion criteria, as we excluded all patients who have used folic acid or vitamin B 12 supplementation, as well as different cut-off levels determined for vitamin B 12 deficiency.
  • In addition, Babaie et al did not compare the results with a control group.

In our study, comparing the frequency of vitamin B 12 deficiency between the case and controls revealed a nonsignificant association between melasma and vitamin B 12 deficiency. Although studies have determined the role of vitamin B 12 deficiency in different skin lesions and hyperpigmentation), no other study has determined its deficiency in patients with melasma, and this study, as far as the authors are concerned, is the first to compare its level with a control group with nonsignificant association.

Moreover, it was found that the mean serum levels of Hb, MCV, iron, vitamin B 12, TIBC, and folate were not different between the groups. Moreover, Hb, MCV, vitamin B12, TIBC, and folate these serum parameters were not associated with melasma risk. TIBC represents the sum of all iron binding sites on transferrin, which tightly binds to the cell receptor and controls iron release into plasma; serum iron will be used by various cells and excess levels of iron will be stored as metabolically inactive form, ferritin,

TIBC is thus measured in diagnosis of iron deficiency anemia, iron overload, and chronic inflammatory disorders, The higher TIBC level in women with melasma showed lower iron storage, although the majority of the patients in both groups was within the normal range of TIBC.

The lower iron storage of the patients with melasma was confirmed by a higher frequency of below normal range ferritin level. The results of the present study indicated that women with melasma have a higher frequency of anemia, and also have a lower iron storage. Also, the nutritional habits of patients can significantly affect the serum levels of these parameters, although we excluded vegetarians to minimize the confounding effect of nutrition on melasma and iron profile.

Behrangi and colleagues compared the iron profile of 33 women with melasma with a control group and reported no significant difference between the groups in serum iron, ferritin or TIBC, Their results confirmed that of the present study on no difference between the patients with melasma and the control group in terms of TIBC, but were inconsistent with the results of the present study in terms of serum ferritin and serum iron levels.

This discrepancy could be due to the difference of the baseline serum level of ferritin and serum iron in the study population. In the present study, we tried to exclude any patients with chronic diseases or supplementation use to control the confounders affecting TIBC, serum iron, and ferritin levels.

Babaie et al reported low Hb and serum iron levels in 14.3% and 8.6% of women with melasma, while in the present study, 9.8% of patients with melasma had low Hb level and 21.6% had low serum iron level. This difference can be attributed to the different frequency of anemia in different populations and may also differ according to the underlying diseases and different age groups of the studied population,

  • In the present study, the mean age of the groups had significant differences, which could also be attributed to different iron profile, so we adjusted the analysis regarding the age difference.
  • The study by Qazi et al (2017), comparing 70 nonpregnant women with melasma and the control group, showed a lower mean serum iron and ferritin levels, beside a higher TIBC in the case group,
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These results showed a higher frequency of anemia and lower iron storage in women with melasma, which was consistent to the results of the present study, although the Hb and TIBC levels did not differ between the groups in our study and lower iron storage, was indicated by the lower mean serum iron and higher frequency of below normal range ferritin level.

These results could indicate that women with melasma had low iron levels and storage, but as far as evident in thevitaminB 12 and folate although mean levels were lower in melasma group but they were not expressive enough, which could be followed by future studies. In the present study, all variables were tested for association with MASI, but the results showed no significance.

On the contrary to these results, Qazi et al stated a positive correlation between MASI score and iron profile, which could be also due to the lower mean serum iron in the study by Qazi et al, while only reduced iron storage was detected in the patients of the present study.

  • Anemia is a prevalent health problem, especially in women of reproductive age, who are the main target population of melasma, a disturbing skin disease in women, impairing patients’ quality of life,
  • The target population of the highest frequency of anemia and melasma are the same.
  • Furthermore, the frequency of melasma seems to be higher in pregnant women due to the increased levels of placental, ovarian and pituitary hormones, which results in increased transcription of tyrosinase and dopachrome tautomerase and pigmentation during pregnancy,

The same population, pregnant women, have a high frequency of anemia, These two, the higher frequency of anemia and melasma during pregnancy, may be associated with each other, which have to be further investigated. In the present study, we did not include pregnant women, due to the complex situations and hormone secretion in pregnancy, which may affect this association.

The present study could successfully compare all these parameters between the case and control groups, while the one study investigating all these parameters had the major limitation of a small sample size. Like any other study, our study could also have several limitations. First, the participants did not match with each other in terms of demographics.

Second, all participants were selected from one center that reduce the generalizability of the results. Furthermore, the case-control nature of the study limited confirming causal relationships, although there was no statistically significant association between the variables.

  1. Meanwhile, as the first valid study to investigate this association in an Iranian population, the present study could provide valuable information for the researchers and clinicians.
  2. Conclusion The results of the present study showed that the iron profile of women with melasma is different from that of controls.

The higher frequency of below normal range ferritin and serum iron levels in the case group showed the possible role of anemia in melasma. Limitations Although lower frequency of above normal range vitamin B 12 and folate showed a lower iron storage in women with melasma, the initial hypothesis of the study (the association of melasma as hyperpigmentation with vitamin B 12 and serum folate deficiency) was not confirmed, as hemoglobin and MCV levels were not different between the groups.

Although we excluded possible factors that could affect vitaminB 12 and serum folate levels and pathogenesis of hyperpigmentation and melasma, there could be several factors affecting the two multifactorial diseases, vitaminB 12 deficiency and melasma, which could not be controlled in the present study.

Future randomized clinical trial or cohort studies can shed light on the association between serum folate and vitaminB 12 and melasma. Ethical approval The study was approved by the Ethics Committee of Iran University of Medical Sciences (code: IR.IUMS.FMD.REC1395.08921215097), and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Kang HY, Suzuki I, Lee DJ, Ha J, Reiniche P, Aubert J, et al. Transcriptional profiling shows altered expression of wnt pathway- and lipid metabolism-related genes as well as melanogenesis-related genes in melasma. J Invest Dermatol 2011; 131(8): 1692-1700. https://doi.org/10.1038/jid.2011.109, Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol 2014; 89(5): 771-782. https://doi.org/10.1590/abd1806-4841.20143063, Katsambas A, Soura E. Quality of life in melasma. In: Melasma and vitiligo in brown skin.E. Handog, M. Enriquez-Macarayo, eds. New Delhi: Springer, 2017: 169-175. https://doi.org/10.1007/978-81-322-3664-1_18, Bagherani N, Gianfaldoni S, Smoller B. An overview on melasma. Pigmentary Disorders 2015; 2(10): 218. https://doi.org/10.4172/2376-0427.1000216, Khoza N, Dlova N, Mosam A. Epidemiology and global distribution of melasma. In: Melasma: a monograph 1st ed. New Delhi: Jaypee Brothers Medical Publisher, 2015: 1-3. https://doi.org/10.5005/jp/books/12401_2, Edalatkhah H, Amani F, Rezaifar G. Prevalence of melasma in women in Ardebil city in 2002. Iran J Dermatol 2004; 7(2): 72-77. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=48038, Mahmood K, Nadeem M, Aman S, Hameed A, Kazmi AH. Role of estrogen, progesterone and prolactin in the etiopathogenesis of melasma in females. J Pak Assoc Dermatol 2016; 21(4): 241-247. http://www.jpad.com.pk/index.php/jpad/article/view/483, Lajevardi V, Ghayoumi A, Abedini R, Hosseini H, Goodarzi A, Akbari Z, et al. Comparison of the therapeutic efficacy and safety of combined oral tranexamic acid and topical hydroquinone 4% treatment vs. topical hydroquinone 4% alone in melasma: a parallel-group, assessor- and analyst-blinded, randomized controlled trial with a short-term follow-up. J Cosmet Dermatol 2017; 16(2): 235-242. https://doi.org/10.1111/jocd.12291, Amin N, Mashhood AA, Bilal A. Association of epidermal melasma with skin phenotypes and other contributing factors. J Pak Assoc Dermatol 2016; 26(3): 188-192. https://pdfs.semanticscholar.org/7197/6346aaa4dbcb9a41f6bb8103199f18e7b022.pdf, Rostami Mogaddam M, Safavi Ardabili N, Iranparvar Alamdari M, Maleki N, Aghabalaei Danesh M. Evaluation of the serum zinc level in adult patients with melasma: Is there a relationship with serum zinc deficiency and melasma? J Cosmet Dermatol 2018; 17(3): 417-422. https://doi.org/10.1111/jocd.12392, Ping W, Guohua L, Huihui L, Zhengwen W. Determination of trace elements in pregnant and non-pregnant patients with melasma. Trace Elem Sci 1997; 8. http://en.cnki.com.cn/Article_en/CJFDTotal-GWYS199708006.htm, Niiyama S, Mukai H. Reversible cutaneous hyperpigmentation and nails with white hair due to vitamin B 12 deficiency. Eur J Dermatol 2007; 17(6): 551-552. https://doi.org/10.1684/ejd.2007.0285, Karadag AS, Tutal E, Ertugrul DT, Akin KO, Bilgili SG. Serum holotranscobalamine, vitamin B 12, folic acid and homocysteine levels in patients with vitiligo. Clin Exp Dermatol 2012; 37(1): 62-64. https://doi.org/10.1111/j.1365-2230.2011.04142.x, Najad SB, Khodaiiani E, Herizchi H, Mehrabi P. Frequency of iron deficiency anemia, folate and vitamin B 12 deficiency in patients with melasma. Med J Tabriz Univ Med Sci 2012; 34(2): 12-15. https://www.sid.ir/en/journal/ViewPaper.aspx?id=284349, WHO. The global prevalence of anaemia in 2011. Geneve: World Health Organization, 2015; 43 p. https://apps.who.int/iris/handle/10665/177094, Behrangi E, Baniasadi F, Esmaeeli S, Hedayat K, Goodarzi A, Azizian Z. Serum iron level, ferritin and total iron binding capacity level among nonpregnant women with and without melasma. J Res Med Sci 2015; 20(3): 281-283. https://www.ncbi.nlm.nih.gov/pubmed/26109976, Qazi I, Dogra NK, Dogra D. Serum Iron profile in Female patients of Melasma: A case control study. Asian Pac J Health Sci 2017; 4 (2): 141-146. https://doi.org/10.21276/apjhs.2017.4.2.24, Dermatology atlas for skin of color.D. Jackson-Richards, A.G. Pandya, eds. Berlin: Springer-Verlag Berlin Heidelberg, 2014; 321 p. https://doi.org/10.1007/978-3-642-54446-0, Pandya AG, Hynan LS, Bhore R, Riley FC, Guevara IL, Grimes P, et al. Reliability assessment and validation of the melasma area and severity index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol 2011; 64(1): 78-83. https://doi.org/10.1016/j.jaad.2009.10.051, Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013; 368(2): 149-160. https://doi.org/10.1056/NEJMcp1113996, Kräutler B. Vitamin B12: chemistry and biochemistry. Biochem Soc Trans 2005; 33(Pt 4):806-810. https://doi.org/10.1042/BST0330806, Kannan R, Ng MJ. Cutaneous lesions and vitamin B12 deficiency: an often-forgotten link. Can Fam Physician 2008; 54(4): 529-532. https://www.ncbi.nlm.nih.gov/pubmed/18413300, Soldin OP, Bierbower LH, Choi JJ, Choi JJ, Thompson-Hoffman S, Soldin SJ. Serum iron, ferritin, transferrin, total iron binding capacity, hs-CRP, LDL cholesterol and magnesium in children; new reference intervals using the Dade Dimension Clinical Chemistry System. Clin Chim Acta 2004; 342(1-2): 211-217. https://doi.org/10.1016/j.cccn.2004.01.002, Gottschalk R, Wigand R, Dietrich CF, Oremek G, Liebisch F, Hoelzer D, et al. Total iron-binding capacity and serum transferrin determination under the influence of several clinical conditions. Clin Chim Acta 2000; 293(1-2): 127-138. https://doi.org/10.1016/s0009-8981(99)00242-9, Taher AT, Musallam KM, Inati A. Iron overload: consequences, assessment, and monitoring. Hemoglobin 2009; 33 Suppl 1: S46-S57. https://doi.org/10.3109/03630260903346676, Moin A, Jabery Z, Fallah N. Prevalence and awareness of melasma during pregnancy. Int J Dermatol 2006; 45(3): 285-288. https://doi.org/10.1111/j.1365-4632.2004.02470.x, Esmat B, Mohammad R, Behnam S, Shahrzad M, Soodabeh T, Minoo A, et al. Prevalence of iron deficiency anemia among Iranian pregnant women; a systematic review and meta-analysis. J Reprod Infertil 2010; 11(1): 17-24. https://www.ncbi.nlm.nih.gov/pubmed/23926476,

About the Authors: Azadeh Goodarzi – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. https://orcid.org/0000-0002-1249-4429, Elham Behrangi – MD, Associate Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

https://orcid.org/0000-0002-6545-3460, Afsaneh Sadeghzadeh Bazargan – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. https://orcid.org/0000-0003-1102-6241, Masoomeh Rohaninasab – MD, Assistant Professor, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

https://orcid.org/0000-0002-2862-6422, Fatemeh Sadat Hosseini-Baharanchi – MA, MS, PhD, Assistant Professor, Minimally Invasive Surgery Research Center, & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

  • Https://orcid.org/0000-0003-1633-2635.
  • Mahsa Shemshadi – MD, Resident of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
  • Https://orcid.org/0000-0002-6912-0532,
  • Elham Vafaei – MD, General Practitioner, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

https://orcid.org/0000-0002-5684-6625, Received 9 June 2019, Revised 4 August 2019, Accepted 18 February 2020 © 2019, Goodarzi A., Behrangi E., Sadeghzadeh-Bazargan A., Roohaninasab M., Hosseini-Baharanchi F.S., Shemshadi M., Vafaei E. © 2019, Russian Open Medical Journal Correspondence to Elham Vafaei.

What hormone imbalance causes melasma?

Melasma is a skin condition that causes patches of dark skin on areas of the face exposed to the sun. Melasma is a common skin disorder. It most often appears in young women with brownish skin tone, but it can affect anyone. Melasma is often associated with the female hormones estrogen and progesterone. It is common in:

Pregnant womenWomen taking birth control pills ( oral contraceptives )Women who are taking hormone replacement therapy (HRT) during menopause.

Being in the sun makes melasma more likely to develop. The problem is more common in tropical climates. The only symptom of melasma is a change in skin color. However, this color change can cause distress about your appearance. The skin color changes are most often an even brown color.

Creams that contain certain substances to improve the appearance of melasmaChemical peels or topical steroid creamsLaser treatments to remove the dark pigment if melasma is severeStopping hormone medicines that may be causing the problemMedicines taken by mouth

Melasma often fades over several months after you stop taking hormone medicines or your pregnancy ends. The problem may come back in future pregnancies or if you use these medicines again. It may also come back from sun exposure. Contact your provider if you have darkening of your face that does not go away.

Wear clothing such as hats, long-sleeved shirts, long skirts, or pants.Try to avoid being in the sun during midday, when ultraviolet light is most intense.Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 30. Pick a broad-spectrum sunscreen that blocks both UVA and UVB light.Apply sunscreen before going out into the sun, and reapply often – at least every 2 hours while in the sun.Use sunscreen year-round, including in the winter.Avoid sun lamps, tanning beds, and tanning salons.

Other things to know about sun exposure:

Sun exposure is stronger in or near surfaces that reflect light, such as water, sand, concrete, and areas painted white.Sunlight is more intense at the beginning of the summer.Skin burns faster at higher altitudes.

Chloasma; Mask of pregnancy; Pregnancy mask Dinulos JGH. Light-related diseases and disorders of pigmentation. In: Dinulos JGH, ed. Habif’s Clinical Dermatology,7th ed. Philadelphia, PA: Elsevier; 2021:chap 19. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM.

  1. Disturbances of pigmentation.
  2. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds.
  3. Andrews’ Diseases of the Skin: Clinical Dermatology,13th ed.
  4. Philadelphia, PA: Elsevier; 2020:chap 36.
  5. Updated by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ.
  6. Also reviewed by David C.

Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Can B12 reverse hyperpigmentation?

Hyperpigmentation as a Primary Symptom of Vitamin B12 Deficiency: A Case Report Monitoring Editor: Alexander Muacevic and John R Adler 1 Internal Medicine, Ziauddin University, Karachi, PAK Find articles by 2 School of Medicine, University of Michigan, Ann Arbor, USA Find articles by 3 Internal Medicine, Ramaiah Medical College, Bangaluru, IND Find articles by 4 College of Medicine, Al-Quds University, Jerusalem, PSE Find articles by 5 Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA Find articles by 6 Internal Medicine, University of Sulaimani, Sulaymaniyah, IRQ Find articles by 7 Acute Medicine, University Hospitals of Derby and Burton, Burton, GBR Find articles by 8 Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK Find articles by © 2022, Jangda et al.

  1. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
  2. The presentation of vitamin B12 deficiency varies from being asymptomatic to affecting multiple organ systems.

In addition, several systemic diseases can be associated with generalized weakness and hyperpigmentation. However, vitamin B12 deficiency rarely presents with hyperpigmentation as an initial symptom. We present a rare case of a 22-year-old college student who presented with hyperpigmentation as the only physical manifestation of early vitamin B12 deficiency.

This case underlines the need to rule out vitamin B12 deficiency when clinicians encounter hyperpigmentation as a solo presentation and also emphasizes the significance of early treatment in preventing the irreversible neurological manifestations of vitamin B12 deficiency. Keywords: cutaneous manifestation of vitamin b12 deficiency, adisonian mimick, vitamin b12 deficiency symptoms, cutaneous hyperpigmentation, hyperpigmentation The deficiency of vitamin B12 can cause specific skin manifestations, such as hyperpigmentation, vitiligo, angular stomatitis, and hair and nail changes,

However, the most common dermatological manifestation is hyperpigmentation, which often occurs in combination with systemic findings, including macrocytic anemia, pancytopenia, and subacute combined degeneration of the cord (SCD), When dermatological features occur in the dissociation of systemic findings, the deficiency of vitamin B12 can be overlooked.

As a result, such cases are rarely reported, A 22-year-old male student presented with a four-month history of the progressive development of hyperpigmentation on his knuckles. At first, he thought sun exposure was the primary cause, so he started wearing gloves during the day to prevent any exposure.

Nevertheless, his hyperpigmentation gradually worsened with time, involving his knuckles, dorsal aspect of interphalangeal joints, distal phalanges, and the foot (dorsal surface of interphalangeal joints). His fingernails and the palmar surfaces of his hands and feet were spared.

  1. He denied the development of any rash or skin allergy before the onset of hyperpigmentation.
  2. Apart from hyperpigmentation being his only primary presentation, no other systemic complaints were present in the patient.
  3. His previous medical and medication history was unremarkable.
  4. He had never undergone any surgery and had never been on a restricted diet.
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His BMI was 20, and his weight had been stable over the past 12 months. On examination, vital signs were stable with no pallor. However, considerable hyperpigmentation in the form of brownish discoloration was noted, which was more marked on the dorsal aspect of the hands (Figure ).

  • There were no signs of hyperpigmentation in the oral cavity.
  • A detailed systemic examination revealed no positive findings, including unremarkable neurological assessments.
  • Based on the physical findings, the suspicion of autoimmune disorders was ruled out.
  • Investigations were carried out primarily to rule out the systemic causes of hyperpigmentation.

Investigations included complete blood counts, serum electrolytes, 8 a.m. plasma cortisol levels, vitamin B12, and serum folic acid levels. His morning cortisol and serum electrolytes were within normal ranges, excluding adrenal insufficiency (Table ).

Lab parameters Value (normal range)
Hb (g/dL) 13.6 (13.5-17.5)
MCV (fl) 96.8 (80-100)
WBC (X10 9 /l) 7.2 (4.5-11)
Platelets (X10 3 /ul) 300 (150-400)
Serum Vitamin B12 (pg/mL) 125 (210-911)
Serum Iron (μg/dL) 110 (67-175)
Serum Folic Acid (ng/mL) 6.8 (2-20)
Serum Cortisol 8 a.m (μg/dL) 13.8 (5-23)
Na (mEq/L) 141 (136-146)
K (mEq/L) 3.8 (3.5-5)
Cl (mmol/L) 96 (95-105)

His serum vitamin B12 levels were 125 pg/mL (210-911 pg/mL). All other investigations were normal. He was diagnosed with one of the rare early manifestations of vitamin B12 deficiency, as all other causes for hyperpigmentation were ruled out other than low serum vitamin B12 levels. Treatment with intramuscular injection of vitamin B12 was initiated (1000 mcg IM twice a week for a month, plus 100 mcg orally per day). Further investigations were carried out to rule out pernicious anemia. Moreover, improvement was noticed within two weeks of initiating treatment (Figure ). Post-treatment improvement. At his second follow-up after three weeks, his vitamin B12 levels were over 300 pg/mL, and his hyperpigmentation was completely resolved. The antibody titer for pernicious anemia was also unremarkable, making a lack of vitamin B12 in the diet the sole cause of this occurrence. However, the oral dose of vitamin B12 of 100 mcg was continued for a month, and the patient was advised to increase their dietary intake of vitamin B12 from animal or fortified foods. Vitamin B12 plays an integral role in the synthesis of DNA; its deficiency results in multisystem complications, Plasma concentration below 200 pg/ml (148 pmol/L) is considered deficient. In the general population, the prevalence ranges from 3-5% to 5-20% among people aged >65 years, The deficiency affects all age groups and causes a range of conditions, most commonly affecting the hematological and neurological systems, The neurological complications include SCD, peripheral neuropathy, and psychiatric changes, Many mucocutaneous findings, including hair and nail changes and hyperpigmentation, especially of the hands and feet, are associated with vitamin B12 deficiency, Reversible skin and mucosal hyperpigmentation are the most commonly found skin manifestations of vitamin B12 deficiency, However, most cases present alongside systemic findings, such as malabsorption, anemia, pancytopenia, and variable neuropsychiatric problems, Interestingly Dr. Bramwell Cook defined a syndrome in late 1944 related to vitamin B12 deficiency, entailing hyperpigmentation, glossitis, and macrocytic megaloblastic anemia as its primary features. It has been observed that up to 1 in 5 patients with a deficient B12 level may have cutaneous hyperpigmentation, Rarely, as observed in this patient, has skin hyperpigmentation been reported as the only symptom of vitamin B12 deficiency, Other more common causes of hyperpigmentation include systemic causes, such as Addison disease, hyperthyroidism, hemochromatosis, and certain primary skin disorders. Protein-energy malnutrition, zinc deficiency, and pellagra can also cause hyperpigmentation, In one study, Baker SJ et al. observed that 21 patients who presented with other primary findings of vitamin B12 deficiency also had hyperpigmentation, Moreover, Aaron S et al. found that 41% (26 out of 63) of his patients presented with cutaneous changes as a primary symptom of vitamin B12 deficiency. While 52% of these 26 patients (22% of the total) presented with mucosal changes, glossitis was specifically seen in 31% (19 out of 63), hyperpigmentation of the skin in 19% (12 out of 63), hair changes in 9% (6 out of 63), angular stomatitis in 8% (5 out of 63), and lastly, vitiligo was seen in only 3% (2 out of 63), Therefore, regardless of the presence of neurological symptoms, SCD should be suspected in patients with skin hyperpigmentation, as the neurological manifestations can be a late finding, Skin hyperpigmentation in B12 deficiency was most commonly observed on the hands and feet (dorsal aspect), with the knuckles being the most prominent site. The darkening of sole and palmar creases, interphalangeal joints, and terminal phalanges was also observed, It remains questionable whether the development of hyperpigmentation is responsive to specific serum vitamin B12 levels, The pathophysiologic mechanism of hyperpigmentation involves increased melanin synthesis and the inadequate transfer of the pigment from the melanocytes to the nearby keratinocytes. Increased melanin synthesis occurs with the tyrosinase enzyme’s raised activity, The increase in melanin synthesis is considered the leading mechanism in lieu of inadequate melanin transfer, Electron microscopy showed the presence of extensive megaloblastic keratinocytes encircling the melanosomes containing melanocytes. The treatment consists of oral and/or parenteral vitamin B12 depending on the severity of symptoms and the level of deficiency. When hyperpigmentation is the primary presentation, oral treatment is preferred over parenteral treatment. The resolution period of the hyperpigmentation tends to vary from 6 to 12 weeks after the treatment, Recurrence of hyperpigmentation in our patient was not observed at a one-year follow-up. A thorough systemic examination should be performed in patients presenting with hyperpigmentation of the skin. It should be investigated for a deficiency of vitamin B12, besides ruling out the other common causes. Alongside providing adequate treatment, the patient should be followed up for a few weeks to examine for the resolution and screen for neurological manifestations, as there can be a late manifestation in some patients. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Consent was obtained or waived by all participants in this study 1. Cutaneous lesions and vitamin B12 deficiency: an often-forgotten link. Kannan R, Ng MJ., Can Fam Physician.2008; 54 :529–532.2. Skin hyperpigmentation as the presenting symptom of subacute combined degeneration of the spinal cord. Alhazmi A, Almalki A, Ghazala S. Case Rep Neurol Med.2017; 2017 :7140908.3. Knuckle pigmentation as an early cutaneous sign of vitamin B12 deficiency: a case report. Srivastava A, Choudhary S. JNMA J Nepal Med Assoc.2020; 58 :798–800.4. Vitamin B12 deficiency presenting with hyperpigmentation and pancytopenia. Rao VR. J Family Med Prim Care.2018; 7 :642–644.5. Reversible hyperpigmentation in vitamin B12 deficiency: an Addisonian mimic in clinical practice. Awindaogo RA, Ekem I, Awuku NA, et al. PAMJ Clin Med.2020; 4 :109.6. Vitamin B12 deficiency induces imbalance in melanocytes homeostasis-a cellular basis of hypocobalaminemia pigmentary manifestations. Rzepka Z, Respondek M, Rok J, Beberok A, Ó Proinsias K, Gryko D, Wrześniok D. Int J Mol Sci.2018; 19 7. A vitamin B deficiency syndrome allied to sprue. Cook AB. Ind Med Gaz.1944; 79 :429–437.8. Generalised hyperpigmentation in vitamin B12 deficiency. Santra G, Paul R, Ghosh SK, Chakraborty D, Das S, Pradhan S, Das A. J Assoc Physicians India.2014; 62 :714–716.9. Hyperpigmentation of skin. A sign of vitamin-B12 deficiency. Baker SJ, Ignatius M, Johnson S, Vaish SK. Br Med J.1963; 1 :1713–1715.10. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Aaron S, Kumar S, Vijayan J, Jacob J, Alexander M, Gnanamuthu C. Neurol India.2005; 53 :55–58.11. Hyperpigmentation with vitamin B12 deficiency in an adolescent girl. Hasan SH, Samad R, Das JC, Ara F. J Bangladesh Coll Phys Surg.2021; 39 :62–67. : Hyperpigmentation as a Primary Symptom of Vitamin B12 Deficiency: A Case Report

Is melasma caused by high or low estrogen?

What are the causes of melasma? – Dr. Keira shared, “Melasma appears on women’s skin much more often than men’s skin. In fact, though over 5 million Americans are affected by melasma, 90% of them are women. “What causes melasma is not yet fully understood, though current theories suggest that hormones, UV exposure, inflammation, and genetics are all major influencers of the disorder.” “Melasma likely occurs when the pigment producing cells in the skin (melanocytes) produce too much pigment (or melanin),” Dr.

Keira explains. “The underlying hormone responsible for triggering the melanocytes is melanocyte stimulating hormone (MSH). This hormone increases the production of melanin, which is responsible for darkening the skin.” People with darker skin are more prone to melasma because they have more active melanocytes than people with light skin.

“At all stages of women’s lives, hormones can be in flux. When it comes to melasma, research has found that elevated levels of estrogen, and to a lesser degree elevated progesterone levels, are associated with increased skin pigmentation. “This is why melasma is often seen during pregnancy, and in those women using oral contraceptive pills and hormone replacement therapy (HRT) – because hormonal levels are elevated and stimulate melanocytes both directly and indirectly to increase pigment production.” Hormones + stress: Cortisol is part of the problem, says Dr.

  1. Eira, so avoiding stress where possible can help manage the condition.
  2. As you become stressed (whether it be physical, psychological or emotional), your body produces increasing levels of the hormone cortisol to help cope with the stress.” More cortisol creates an imbalance in estrogen levels, and “these elevated estrogens upregulates MSH levels, which in turn increases the amount of melanin produced.

Re-establishing balance in stress and hormonal levels are one of the keys to prevention and management.” Hormones + thyroid: Other hormones also have been shown to play a role in melasma, according to Dr. Keira. Studies highlight that individuals with thyroid disorders, specifically autoimmune thyroid conditions, had a higher incidence of melasma as well.

  • Exposure to sunlight and heat : “Ultraviolet (UV) light from the sun stimulates your melanocytes.
  • This means that just a small amount of vitamin d or sun exposure can make melasma return after fading,” says Dr. Keira.
  • This is why melasma often is worse in summer due to higher levels of sun exposure.
  • It also is the main reason why many people with melasma have recurrences.it comes back, again and again.” Sun exposure can either trigger melasma, or contribute to exacerbation of the skin patches, according to Dr.

Keira. “What’s more, the sun’s heat, and heat of any kind, is a common trigger for melasma as it increases vascular dilatation which is a component of this condition. In addition, heat may lead to more inflammation which can also stimulate melanocyte pigment production.

What does this mean? Sun screens and other surface protection may not be enough to keep the skin from darkening.” Genetics: While women constitute the vast majority of those with melasma, it’s not limited to women alone. In fact, says Dr. Keira, “Recent studies have found that melasma tends to run in families regardless of whether a man or women inherits the condition.

In fact, one study showed that 70 percent of Latino men with melasma also had a family member with melasma.” Irritation from skin care products: Be careful of how you treat your skin, says Dr. Keira. “If a product or procedure irritates your skin whether due to heat or friction resulting in trauma, melasma can worsen due to stimulating melanin production.

Can melasma be cured completely?

Is there a cure for melasma? – Melasma is hard to treat. To determine a treatment plan, your healthcare provider will have to first figure out what’s possibly causing the melasma. Is it sunlight? Your birth control? Genetics? Your soap? Too much screen time? Depending on the person, melasma may go away on its own, it may be permanent, or it may respond to treatment within a few months.

  • Hormone treatments, specifically ones that involve estrogen.
  • Birth control, specifically oral contraceptive pills that contain estrogen and progesterone.
  • LED light from your television, laptop, cell phone and tablet.
  • Makeup you find irritating to your skin.
  • Medications that may cause or worsen melasma.
  • Scented soaps.
  • Skin care products that irritate your skin.
  • Tanning beds.
  • Waxing, which can aggravate the melasma.

How do you reduce melanin internally?

Green tea – Green tea has a compound called epigallocatechin gallate (EGCG). A 2015 study found that EGCG can prevent melanin accumulation. It works by inhibiting an enzyme needed to make melanin. Every person’s body continually creates melanin. The amount is determined by genetics.

Higher chances of sun damage. Less melanin means less protection from the sun’s rays. This raises the risk of wrinkles, uneven texture, and discoloration. Increased risk of skin cancer. The high risk of sun damage also increases your chances of developing skin cancer, Irritation and sensitivity. The actual process of skin lightening is harsh on the skin. Many treatments can cause side effects like redness, itchiness, and contact dermatitis,

Injectable skin lightening products are available, but the Food and Drug Administration (FDA) do not recommend them. There is not enough evidence that they work, and there may be health risks. Skin lightening treatments can temporarily reduce your skin’s melanin production.

Most of them work by suppressing the enzyme that’s needed to form melanin. However, aside from wearing sunscreen and limiting sun exposure, you can’t lower your body’s overall melanin production. Permanent reduction isn’t possible, since melanin formation is determined by genetics. If you have hyperpigmentation, ask a doctor how to reduce melanin in the affected areas.

They can suggest the appropriate treatments or remedies for your needs.

Can vitamin C reverse melasma?

Vitamin C has been shown to inhibit the production of melanin, slowing or stopping the darkening of the skin caused by dark spots and melasma.