Melasma dermal

Dermal melasma mcreased melanin in the superficial and deep dermis. Clinically, melasma is dark brown to gray and its appearance is not enhanced... 

Histopathology this classifies melasma in epidermal, dermal and mixed. 

On the other hand, when the desired effect is destruction of deeper layers of the dermis and epidermis to eliminate certain lesions, a single deeper peel may be a better indication than repeating several peels to the Grenz zone, as is the case when treating lentigines and mixed or dermal melasma. 

It is common to combine different concentrations of TCA during the same peel session a TCA peel to the papillary dermis (Unideep ) can be applied locally for dermal melasma on the forehead, for example, while a TCA to the Grenz zone (Easy TCA ) is applied to the rest of the face (to even out the results) after focal treatment of keratoses or lentigines with a TCA to the reticular dermis (Only Touch ). 

Increased solar radiation induced dermal changes in the cohort with the diagnosis of melasma [120]. 

Dermal (10-15%) - no enhancement of color contrast Mixed (20%) - both enhancement and no color accentuation in different areas on the same patient Indeterminate - in very dark-skinned individuals, one cannot see the lesions under Wood s light Histopathologically and ultrastructurally, normal skin presents with melanin confined to the basal layer. Melasma lesions have more melanin in the whole epidermis, with increased number of melanocytes and widely dispersed melanosomes in the keratinocytes [19, 77, 126]. Dermal solar elastosis is likewise evident in lesional areas [19, 77]. 

Although this histopathological classification of melasma is widely accepted [45], Kang et al. s study suggested that there may not be a true dermal type since the melanophages in the demtis of this type of melasma may actually be undiagnosed acquired bilateral nevus of Ota-like macules (ABNOM) or Hori s macules [77]. 

Figure 9.8 A 67-year-old female was treated tor (A) dermal melasma with (B) a Melanage" peel. (C) 6 weeks after the peel...

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