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2018, Número 1

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Dermatología Cosmética, Médica y Quirúrgica 2018; 16 (1)


Guías de diagnóstico y manejo de melasma

Arellano MI

Idioma: Español
Referencias bibliográficas: 92
Paginas: 12-23
Archivo PDF: 167.08 Kb.


RESUMEN

Introducción: el melasma es una hipermelanosis adquirida, crónica, recurrente y simétrica que se caracteriza por manchas en áreas expuestas al sol, circunscritas, de color café claro a oscuro y ocasionalmente grisáceo, de tono variable. Es un padecimiento cutáneo que afecta la calidad de vida. Su incidencia es de entre 14.5 y 56% en mujeres embarazadas, y de 11.3 a 46% en quienes utilizan anticonceptivos orales. Se necesitan lineamientos clínicos y de manejo del melasma en nuestro país.
Material y métodos: se reunió un grupo de expertos para emitir recomendaciones sobre melasma, enfocadas a pacientes mexicanos. Las recomendaciones fueron desarrolladas por un grupo de 15 dermatólogos mexicanos, de instancias hospitalarias públicas y de práctica privada donde se trata a pacientes con dicha enfermedad. Las recomendaciones se calificaron con base en el sistema grade (Grading of Recommendations Assessment, Development and Evaluation) y por medio de un cuestionario Delphi modificado. Este instrumento constaba de reactivos donde se preguntaba sobre la definición, los factores desencadenantes, la fisiopatología, la epidemiología y el tratamiento del melasma. Posterior a la recepción del cuestionario resuelto, se llevó a cabo una reunión con el comité de expertos para la evaluación y análisis de las respuestas, así como para la redacción de las recomendaciones consensuadas.
Generalidades: se describe la fisiopatología del melasma considerando factores genéticos, de exposición solar, hormonal, luz visible, procesos inflamatorios y factores dérmicos, así como aspectos de patología y de manifestaciones clínicas.
Recomendaciones: se emitieron recomendaciones en los temas de diagnóstico, clinimetría, tratamiento tópico, tratamiento sistémico, procedimientos de quimioexfoliación superficial y media.


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  88. Lee DB, Suh HS y Sung C, A comparative study of low-fluence 1064-nm q-switched nd:yag laser with or without chemical peeling using Jessner’s solution in melasma patients, J Dermatolog Treat 2014; 25(6):523-8.

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  91. Wanitphakdeedecha R, Keoprasom N, Eimpunth S y Manuskiatti W, The efficacy in melasma treatment using a 1 410 nm fractional photothermolysis laser, J Eur Acad Dermatol Venereol 2014; 28:293-7.

  92. Wind BS, Kroon MW, Meesters AA et al., Non-ablative 1 550 nm fractional laser therapy versus triple topical therapy for the treatment of melasma: a randomized controlled split-face study, Lasers Surg Med 2010; 42(7):607-12.




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