University of Nice-Sophia Antipolis, France.
J Eur Acad Dermatol Venereol. 2009 Nov;23(11):1254-62. doi: 10.1111/j.1468-3083.2009.03295.x. Epub 2009 May 19.
It has been generally believed that the four main causes of melasma are pregnancy, hormonal contraception, family history and sun exposure; however, there are few published comprehensive studies that confirm these assertions. The Pigmentary Disorders Academy - an international group of experts in pigmentary disorders - designed and conducted a global survey of women to investigate the effect of these factors on onset and chronicity of melasma and the course of the disease in order to gain a better understanding of the causative factors associated with this disorder, with a particular focus on hormonal factors and UV exposure in females.
A 40-item largely self-administered questionnaire was completed by 324 women being treated for melasma in nine clinics worldwide.
The mean age at onset of melasma was 34 years, and 48% of subjects questioned had a family history of melasma (97% in a first-degree relative). Subjects with family history of melasma tended to have darker skin (90% types III-VI) compared to those without (77% types III-VI). The most common time of onset was after pregnancy (42%), often years after the last pregnancy, with 29% appearing pre-pregnancy and 26% during pregnancy. Onset was related to darker skin type post-pregnancy (P = 0.002). Risk of onset during pregnancy was associated with having spent more time outdoors (an extra 10 h per week spent working outside increases the odds of onset of melasma during pregnancy by approximately 27%) and an increased maternal age at pregnancy (increased by approximately 8% for each year of age at first pregnancy; P = 0.02). The odds of melasma occurring for the first time during a pregnancy were also increased with multiple pregnancies (twice the odds if 2 vs. 1 pregnancies, three times higher if 3 or more vs. 1 pregnancy). Of the women, 25% who had used hormonal contraception claimed that melasma appeared for the first time after its use, the rate being higher for those without vs. with a family history.
The results suggest that, whilst accepted causes do affect onset of melasma, a combination of these factors often triggers this disorder. These factors may provide further insights into how physicians can manage individual melasma cases, support recommendation of preventative measures and even anticipate treatment results and recurrence.
人们普遍认为，黄褐斑的四个主要原因是妊娠、激素避孕、家族史和阳光照射；然而，很少有发表的综合研究证实这些说法。色素紊乱学院——一个国际色素紊乱专家小组——设计并进行了一项针对女性的全球调查，以研究这些因素对黄褐斑发病和持续性以及疾病过程的影响，从而更好地了解与这种疾病相关的致病因素，特别是激素因素和女性的紫外线暴露。
在全球 9 个诊所接受黄褐斑治疗的 324 名女性完成了一份由 40 个项目组成的大部分自我管理问卷。
黄褐斑发病的平均年龄为 34 岁，97%的患者有家族史（一级亲属中为 48%）。有家族史的患者皮肤往往较暗（90%为 III-VI 型），而无家族史的患者为 77%（III-VI 型）。最常见的发病时间是妊娠后（42%），通常是最后一次妊娠多年后，29%出现在妊娠前，26%出现在妊娠期间。发病与妊娠后皮肤类型较暗有关（P=0.002）。妊娠期间发病的风险与在户外工作时间增加有关（每周额外工作 10 小时，妊娠期间黄褐斑发病的几率增加约 27%）和母亲妊娠年龄增加有关（每增加 1 岁，几率增加约 8%；P=0.02）。如果是多胎妊娠（如果是 2 次妊娠，几率是 1 次妊娠的两倍；如果是 3 次或更多次妊娠，几率是 1 次妊娠的 3 倍），第一次妊娠时出现黄褐斑的几率也会增加。在使用激素避孕的女性中，25%的人声称黄褐斑是在使用后首次出现，而没有家族史的人比有家族史的人出现的比例更高。
结果表明，虽然公认的原因确实会影响黄褐斑的发病，但这些因素的组合往往会引发这种疾病。这些因素可以进一步深入了解医生如何管理个别黄褐斑病例，支持预防措施的建议，甚至预测治疗效果和复发。
