Melasma mixed

Seborrheic keratoses Hypertrophic keratoses Mixed melasma Mixed hyperpigmentation... 

Depressed scars (CROSS technique) Variable response Seborrheic keratoses Hypertrophic keratoses Mixed melasma Mixed hyperpigmentation Poor response... 

Mixed melasma increased melanin in the epidermis and dermis.Clinically, melasma is dark brown and its appearance is not enhanced by Wood s light. 

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. 

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]. 

Topical indomethacin was shown to be effective for epidermal type melasma particularly on the cutaneous upper lip of women [117]. In the author s experience, a study done on 48 Filipino women with epidermal and mixed melasma showed that 8% topical indomethacin applied twice daily for 12 weeks on melasma areas was effective and safe, with a significant difference on... 

Combined peel using salicylic acid 25% in alcoholic solution and TCA 10% gel, in 3-4 settings at 4-5-week intervals, showed regression of epidermal melasma with no relapse even after 6 months post peels significant pigmentation reduction was noted in cases of mixed melasma. With the absence of inflammatory reaction that may lead to PIH, it is safe for patients with darker skin phototypes [143]. 

But in the author s experience on two different studies, using vitamin C or tretinoin 0.1% gel iontophoresis, the Filipino women with epidermal and mixed melasma obtained lightening of their pigmentation whether they were in the treatment or placebo group [54, 55],... 

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