Lutfi R J, Fridmanis M, Misiunas A L, Pafume O, Gonzalez E A, Villemur J A, Mazzini M A, Niepomniszcze H
J Clin Endocrinol Metab. 1985 Jul;61(1):28-31. doi: 10.1210/jcem-61-1-28.
Melasma is localized hyperpigmentation over the forehead, upper lips, cheeks, and chin. In this study, evidence suggesting an association between autoimmune thyroid disorders and melasma and the relationship of thyroid disorders to the origin of melasma is presented. A total of 108 nonpregnant women, aged 20-56 yr, were divided into 2 groups for the purpose of this study: 1) melasma, 84 patients; 2) control group, 24 patients from the Dermatology Clinic matched for age and sex. Microsomal thyroid autoantibodies (MCHA) were sought in all subjects. TRH-TSH tests were performed in patients with melasma and in those women with goiter and/or positive MCHA tests from the control group. Studies were completed with serum T4, T3, and antithyroglobulin antibody (TGHA) measurements in all patients with thyroid abnormalities. In patients with melasma, the frequency of thyroid disorders (58.3%) was 4 times greater than in the control group. The MCHA-negative patients had 1) simple goiter (13.1%), 2) Plummer's disease (2.4%), and 3) TSH hyperresponse to TRH in nongoitrous patients (10.7%). Patients with positive MCHA tests (32.1%) were divided into 2 subgroups. One comprised those women with an apparently normal thyroid gland and thyroid function (n = 7), while the other included all patients with goiter and/or subclinical hypothyroidism (n = 20). Regarding the origin of the melasma, it was found that 70% of women who developed melasma during pregnancy or while using oral contraceptives had thyroid abnormalities compared to 39.4% of patients with idiopathic melasma. Subjects from the control group had a 12.5% incidence of thyroid abnormalities, and only 8.3% had positive MCHA. Estrogen, progesterone, or both could be the triggering factor in the development of melasma in women who have a particular predisposition toward both melasma and thyroid autoimmunity. Patients with idiopathic melasma had a lower frequency of thyroid abnormalities, suggesting that there may be different genetic patterns linked to autoimmune thyroid disease. We conclude that there is a true association between thyroid autoimmunity and melasma, mostly in women whose melasma develops during pregnancy or after ingestion of oral contraceptive drugs.
黄褐斑是前额、上唇、脸颊和下巴部位的局限性色素沉着。本研究展示了自身免疫性甲状腺疾病与黄褐斑之间存在关联的证据，以及甲状腺疾病与黄褐斑病因的关系。为了本研究的目的，将108名年龄在20至56岁之间的非妊娠女性分为两组：1）黄褐斑组，84例患者；2）对照组，24例来自皮肤科诊所、年龄和性别相匹配的患者。检测了所有受试者的微粒体甲状腺自身抗体（MCHA）。对黄褐斑患者以及对照组中患有甲状腺肿和/或MCHA检测呈阳性的女性进行了促甲状腺激素释放激素 - 促甲状腺激素（TRH - TSH）试验。对所有甲状腺异常的患者进行血清总甲状腺素（T4）、总三碘甲状腺原氨酸（T3）和抗甲状腺球蛋白抗体（TGHA）测量后完成研究。在黄褐斑患者中，甲状腺疾病的发生率（58.3%）是对照组的4倍。MCHA阴性的患者有：1）单纯性甲状腺肿（13.1%），2）普卢默病（2.4%），以及3）非甲状腺肿患者中对TRH的促甲状腺激素高反应（10.7%）。MCHA检测呈阳性的患者（32.1%）分为两个亚组。一组包括甲状腺和甲状腺功能明显正常的女性（n = 7），另一组包括所有患有甲状腺肿和/或亚临床甲状腺功能减退的患者（n = 20）。关于黄褐斑的病因，发现孕期或使用口服避孕药期间出现黄褐斑的女性中，70%有甲状腺异常，而特发性黄褐斑患者中这一比例为39.4%。对照组受试者甲状腺异常的发生率为12.5%，只有8.3%的MCHA检测呈阳性。雌激素、孕激素或两者可能是对黄褐斑和甲状腺自身免疫有特殊易感性的女性发生黄褐斑的触发因素。特发性黄褐斑患者甲状腺异常的发生率较低，这表明可能存在与自身免疫性甲状腺疾病相关的不同遗传模式。我们得出结论，甲状腺自身免疫与黄褐斑之间存在真正的关联，主要见于孕期或服用口服避孕药后出现黄褐斑的女性。
