Factores de riesgo para la ocurrencia de melasma en pacientes de un hospital de referencia / Factors associated with the occurrence of melasma in patients at a referral hospital

Objetivo. Determinar los factores de riesgo para la ocurrencia de melasma en pacientes adultos del servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n durante el a¤o 2011. Methodolog¡a. Estudio de casos y controles. La poblacion de estudio estuvo conformada por pacientes atendidos en el Servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n en el Callao. Per£. Se evalu¢ la presencia de factores de riesgo para la ocurrencia de meelasma tales como edad, sexo fototipo cut neo, lugar de procedencia, lugar de nacimiento del paciente, antecedentes de fotoexposici¢n, gestaciones previas y uso de hormonas sexuales femeninas. Se calcularon odds ratios (OR) crudos y ajustados con un nivel de confianza de 95%, mediante el uso del programa estad¡stico Stata12. Resultados. Se evalu¢ 78 casos y 76 controles. El an lisi bivariado mostr¢ que tanto el sexo femenino (OR, 10,2; IC95% 3,3-30,9), el haber nacido en Lima a Callao (OR, 2,7; IC95%, 1,2-160,4) asi como la procedencia de los padres de Lima o Callao (OR padre, 16; IC95%. 1.9-136; OR madre, 18,7; IC95%, 2,2-160,4) estuvieron asociados a la presencia de melasma. el uso de fotoprotector fue mayor entre los casos (p<0,01). el uso de hormonas sexuales femeninas estuvo fuertemente asociado al aumento de melasma (OR, 43,3; IC95%, 3,7 a 505). El an lisis multivariado encontr¢ que el sexo femenino(OR, 10,9; IC95%, 3,3-30,9) y el uso de anticonceptivos orales (OR, 44,9; IC95%, 3,35-603,9) constituyeron factores de riesgo para la presencia de melasma, con ajuste para variables potencialmente confusoras como el sexo del producto de la £¤tima gestaci¢n, lugar de nacimiento as¡ como de la procedencia del padre y la madre. Conclusion. El sexo femenino y el uso de anticonceptivos orales contituyen factores de riesgo para melasma en pacientes del Hospital Daniel A. Carri¢n.

Objective. Evaluated the factors associated with the ocurrence of melasma in adult patients of the Dermatology Department of the Hospital Nacional Daniel A. Carrion in 2011. Methods. We conducted a case-control study. The study population consisted of patients attending the Dermatology Department of the Hospital Nacional Daniel A. Carri¢n in Callao, Per£. We evaluated the presence of factors associated with the ocurrence of melasma such as age, sex, skin phototype, place of origin and birth of the patient, history of photo exposure, previous pregnancies, and use of sesual hormones. We calculated crude and adjusted ORs with a confidence level of 95% using the statistical software stata 12. Results. We evaluated 78 cases and 76 controls. The bivariate analysis showed that female sex (OR, 10,2; 95%CI, 3,3-30,9), being born in Lima and Callao (OR, 2,7;95%CI, 1,2-6,2) and parents origin of Lima and Callao (father OR, 16; 95% CI, 2,2-160,4) were associated with the presence of melasma. The use of sunscreen was higher among cases (p<0,01). The use of secual hormones was strongly associated with melasma (OR, 43,3; 95%CI, 3,35-603,9) as the only factor associated with the occurrence of melasma, adjusted by the sex of the baby, place of birth and origin of the father and the mother. Role of female gender was not evaluated because of dependency among variables. conclusion. Melasma is a highly prevalent entity in our environment female gender and the uso of hormonal medication were identified as only factors associated to this condition in our population.

Fotoproteção, melasma e qualidade de vida em gestantes / Photoprotection, melasma and quality of life in pregnant women

OBJETIVO: Avaliar hábitos de exposição solar e fotoproteção entre gestantes de um hospital público, orientação sobre fotoproteção durante o pré-natal, presença de melasma e seu impacto na qualidade de vida. MÉTODOS: Estudo transversal descritivo realizado em puérperas, com mais de 18 anos, participantes de um programa de assistência pré-natal da Região Sul do Brasil. A amostra foi não probabilística por conveniência. A coleta de dados ocorreu de julho a agosto de 2011, empregando-se entrevista direta, utilizando questionário estruturado para obter informações pessoais e dos hábitos de fotoproteção durante a gestação, avaliação cutânea e registro fotográfico de lesões mediante consentimento informado. A pele foi classificada em fototipos segundo Fitzpatrick e o melasma foi diagnosticado clinicamente. Entre as portadoras do melasma, foi aplicada a versão do MELASQoL-PB. A análise foi realizada com o programa Statistica®, versão 8.0, sendo o nível de significância p<0,05. RESULTADOS: Na amostra (109 puérperas) predominaram as mulheres brancas (60,6% fototipo III), jovens (média de idade 24,4 anos DP=6,1) e donas de casa (59,6%). A maioria (80%) permanecia exposta ao sol por 1-2 horas por dia entre às 10 e 15 horas, e, destas, 72% não aplicavam fotoprotetor alegando falta de hábito. Outros meios físicos de proteção solar eram utilizados por 15% destas pacientes. Informação durante o pré-natal sobre os riscos da exposição solar foi relatada por 34% das puérperas. Houve uma tendência a uma associação significativa entre a orientação no pré-natal e uso diário de protetor solar. Cerca de 20% das puérperas apresentavam melasma. A média do escore do MELASQol-PB (25) apontou impacto negativo na qualidade de vida dessas pacientes. CONCLUSÕES: Nestas puérperas, a exposição solar ocorreu em horários impróprios, sem orientação adequada e sem uma efetiva proteção solar. As portadoras de melasma queixavam da aparência da pele, frustração e constrangimento.

PURPOSE: To evaluate habits of sun exposure and sun protection of pregnant women in a public hospital, to assess orientation about photo protection during the prenatal care, and to detect the presence of melasma and its impact on their quality of life. METHODS: A descriptive cross sectional study conducted among women of 18 years old and older, after delivery, who participated in a program of prenatal care in the South Region of Brazil. The sample was non-probabilistic by convenience. Data collection occurred from July to August 2011 through direct interview using a structured questionnaire to obtain personal information and photo protection habits during pregnancy, skin assessment and photographic record of lesions through informed consent. The skin was classified per Fitzpatrick's phototypes and the melasma was diagnosed clinically. In the patients with melasma, the MELASQoL-PB version was applied. The analysis was performed using Statistica®, version 8.0, and the significance level of p<0.05. RESULTS: In the sample (109 mothers) predominated white women (60.6% phototype III), young (average age 24.4 years SD=6.1) and housewives (59.6%). The majority (80%) stayed exposed to sunlight for 1-2 hours per day between 10 am and 3 pm, and from those (72%) did not apply any photoprotection due to lack of sunscreen habit. Other physical means of sun protection were used by 15% of these patients. Information during prenatal care about the risks of sun exposure was reported by 34% of the mothers interviewed. There was a trend toward a significant association between prenatal guidance and daily use of sunscreen (p=0.088). About 20% of mothers had melasma. The average score MELASQol-PB (25) showed a negative impact on quality of life of these patients. CONCLUSION: In these women, sun exposure occurred at inappropriate times, without proper guidance and without the use of an effective sunscreen. The mothers with melasma complained about the appearance of their skin, frustration and embarrassment.

review on sunscreens and their efficacy in the prevention of skin cancers and melasma. Part I

Sunscreens have been used since 1928. At that time they were used to prevent sun burns mostly because of filtering ultraviolet [UV] B light, the major cause of sunburning and tanning. Over recent decades, the knowledge concerning other harmful effects of UVB on the skin and the role of UVA in skin damage has widely grow. In this article, evidence regarding the efficacy of sunscreen use in the prevention of skin cancers and melasma will be reviewed