Malar area

In 1996, nine workers from a Mexican chemical plant were evaluated for the effects of chronic exposure to mono-, ortho- and paradichlorobenzenes. They had a mean exposure of 24 working years and worked in all stages of chemical production. Safety equipment was not used, and direct contact with the chlorobenzenes occurred via the skin and respiratory tract. The nine workers had a polymorphic acneiform eruption consisting mainly of comedones and cysts. All had comedones on the face, predominately in the malar area lesions on the nose, axillae, chest, shoulders, arms, buttocks and thighs were also present. Yellow cysts (2-5 mm in diameter) were found on the malar area of the face, eyelids, penis, scrotum, chest, axilla... 

Limited experience with humans has shown that exposure to even small amounts of the higher chlorinated derivatives, particularly hexachlorodiphenyl oxide, may result in appreciable acneform dermatitis. Chloracne is usually persistent and affects the face, ears, neck, shoulders, arms, chest, and abdomen (especially around the umbilicus and on the scrotum). The most sensitive areas are below and to the outer side of the eye (malar crescent) and behind the ear. The skin is frequently dry with noninflammatory comedones and pale yellow cysts containing sebaceous matter and keratin. 

Initially the eruption, which consists of erythema, edema, blisters, weeping and desquamation, involves the forehead, rims of the ears, the nose, the malar eminences and cheeks, the sides and back of the neck, the extensor surfaces of the forearms and the dorsa of the hands. These reactions commonly spare the shaded areas those under the chin, under the nose, behind the ears and inside the fold of the upper eyelids. There is usually a sharp cut-off at the site of jewelry and at clothing margins. All light-exposed areas need not be affected equally. 

Melasma is a chronic recurrent acquired symmetric cutaneous hypermelanosis, representing a dysfunction of the pigmentary system. Characterized by irregular brown, grayish brown, or tan macules and patches occurring on sun-exposed skin areas, it mostly involves the forehead, malar eminences, mandibular areas, and cutaneous part of the upper lip. Melasma develops slowly, can last for many years, worsens in summer and improves in colder seasons. It may be called chloasma and mask of pregnancy but the widely accepted term for this entity is melasma. 

Bilateral symmetric uniformly hyperpigmented lesions are seen in three clinical patterns [68,98,123,126] Centrofacial (63-64%) - cheeks, forehead, upper lip, nose, and chin Malar (21-27%) - cheeks and nose Mandibular (9-16%) - ramus of the mandible Other areas which may be involved are the dorsal forearms [68], rarely on the nipples and external genitalia [8]. Melasma does not involve the mucous membranes [123]. 

Coal-tar oils, creosote and pitch can produce a comedonal type of acne, which shows a predilection for exposed areas, particularly the malar regions (Bertolini 1989). Coal-tar plant workers, roofers, road maintenance workers and construction workers are among those at risk. Coal-tar acne may be complicated by phototoxic reactions affecting both the skin and the eyes and resulting in hyperpigmentation known as coal-tar melanosis. Late complications include the... 

Pitch acne Tar/pitch Exposed facial areas, especially malar Open comedones... 

Facial characteristics are defined by the skin, muscles and bones. Over the years, the face loses its youthful appearance. Body weight, hormonal changes, ultraviolet radiation, smoking, and gravity lead to the appearance of depressions and wrinkles. In addition, the loss of the skin s elasticity becomes apparent after the age of 30. Areas of the face most affected are the periorbital, malar, forehead, temporal, glabellar, mandibular, mental and perioral zones [14-16]. 

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