ABSTRACT
BACKGROUND: Melasma is a frequent cause of consultations at dermatology departments by dark-skinned patients in Tunisia. OBJECTIVE: To investigate factors that influence melasma severity in a large Tunisian population. METHODS: A total of 197 patients (188 women and 9 men), who attended Tunis Military Hospital for a consultation were included prospectively from August 2005 to August 2006. Disease severity was estimated using the Melasma Area and Severity Index (MASI). Aggravating factors were investigated using multiple logistic regressions. RESULTS: Of the women included, 14% presented phototype III, 45% phototype IV and 41% phototype V; 76% presented a centrofacial melasma phenotype, 23% a malar and 1% a mandibular phenotype. About 60% developed melasma before thirty. Sun exposure was reported as a triggering factor by 51% of women and as an aggravating factor by 84%. Pregnancy was reported as an aggravating factor by 51% of women who had been pregnant, and oral contraceptive use reported by 38% of women exposed to oral contraceptives. The risk of severe melasma was about three times higher for women with age at onset under 30, phototype V and major lifetime sun exposure and about 8 times higher for women exposed to oral contraceptives. CONCLUSION: This study identifies a number of factors associated with the severity of melasma. Further epidemiological studies in this type of population, in particular, to investigate triggering factors, are justified by the aesthetic damage caused by melasma in dark-skinned patients, lack of efficacy of existing treatments, non-compliance with photoprotection recommendations and the challenge of treatment.
Subject(s)
Melanosis/epidemiology , Adolescent , Adult , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Severity of Illness Index , Surveys and Questionnaires , TunisiaABSTRACT
BACKGROUND: Universalis dyschromatosis is a rare genodermatosis. Melanogenesis dysfunction appears to be the main etiology. We report two cases, discussing the clinical features, diagnosis and etiology of this disease. CASE REPORTS: A 21-year-old man was referred for a mixture of achromatic and hyperchromatic lesions that had progressed on sun-exposed skin areas since birth. The histopathologic study evidenced increased melanin content in the basal cell zone but no changes in the aspect or the number of melanocytes. The second case was a 20-year-old man who presented the same clinical features. His brother also had these lesions. A scotch test and a Wood light test were negative. DISCUSSION: Universalis dyschromatosis is a generalized leukomelanoderma. The familial nature of the disease in our second case points out the genetic component. Recent ultrastructure studies have demonstrated the melanogenesis dysfunction involved. The location of the lesions on sun exposed areas points out to the role of ultraviolet light. In Tunisia, Xeroderma pigmentosum is the main differential diagnosis of universalis dyschromatosis.