Melasma on my face! Autoimmunity or allergy?

Zizzle · Post by **Zizzle** » Thu Aug 30, 2012 11:07 am

I've been developing melasma along my hairline for a few months, and it's officially unsightly now. Melasma is darker pigmentation, usually in darker skinned people (I'm half hispanic), that often occurs in pregnancy or while on oral contraceptives (I'm not pregnant or on the pill!) Strangely, it's appearing only on one side of my face, when it's usually symmetrical. It was unchanged for several weeks on my upper right hairline, but today I noticed it's decended all the way to my lower ear level. Melasma is tied to sun exposure, but I've been avoiding the sun all summer due to my photosensitive, autoimmune itchy rash. Also, the melasma is happening on the side of my forehead that is covered by side-swept bangs. The exposed side of my forehead is clear.

What the heck? Can't anything normal or expected happen to me? Does anyone else have this? Is it more common with other autoimmune diseases?

Emedicine said this:

The pathophysiology of melasma is uncertain. In many cases, a direct relationship with female hormonal activity appears to be present because melasma occurs with pregnancy and with the use of oral contraceptive pills. Other factors implicated in the etiopathogenesis of melasma are photosensitizing medications, mild ovarian or thyroid dysfunction, and certain cosmetics.

The most important factor in the development of melasma is exposure to sunlight. Without the strict avoidance of sunlight, potentially successful treatments for melasma are doomed to fail...

Exactly which hormones and what mechanisms are involved in the development of melasma are yet to be determined. Genetic and hormonal influences in combination with ultraviolet radiation are the 2 most important causes of melasma, yet phototoxic and photoallergic medications and certain cosmetics have been reported to cause melasma in rare instances.

Interestingly, the differential diagnosis includes:

•Addison Disease
•Drug-Induced Photosensitivity
•Lupus Erythematosus, Discoid
•Mastocytosis
•Poikiloderma of Civatte
and

Pigmented Contact Dermatitis:

The hyperpigmentation in pigmented contact dermatitis is postulated to be caused by frequent and repeated contact with small amounts of sensitizing allergens primarily in cosmetic and textile materials. Nakayama hypothesized that allergens used in commercial products were too low in concentration to produce typical eczematous dermatitis, but rather accumulation of these allergens resulted allergic contact dermatitis, a type IV cytolytic reaction.[7, 8] This later reaction is characterized by vacuolar degeneration of the basal layer of the epidermis associated with pigment incontinence in the superficial dermis. The melanin pigment is slowly engulfed by macrophages; therefore, resolution of the hyperpigmentation is a prolonged process. Because most cases of pigmented contact dermatitis occur in patients with a darker completion, one hypothesis is that various pigment-genetic interactions contribute to the development of this condition.[4] Furthermore, Imokawa and Kawai have provided clinical evidence that various allergens implicated in allergic contact dermatitis can stimulate melanogenesis.[9]

So, I'm thinking I should suspect my various natural-ish shampoos, conditioners and hair spray. Crazy female hormones? (which wouldn't surprise me), thyroid dysfunction (also likely)?

Ugh, it never ends!!!!!!!!

Post by **tex** » Thu Aug 30, 2012 11:29 am

Zizzle,

Since the primary contributing factor that predisposes to that condition appears to be estrogen and progesterone hormone levels, you're probably on the right track. (Might either your shampoos, conditioners, or hair spray contain hormones?) And yes, thyroid function (or rather dysfunction) can affect hormone levels.

You certainly come up with some interesting mysteries. I hope you can track down the cause of this one.

Tex

jmayk8 · Post by **jmayk8** » Thu Aug 30, 2012 2:48 pm

hello long-lost auto immune sister,
I have had melasma spots for years! I have never been pregnant and have been off the pill for about 2 years. I wear a hat when I am in the sun and but, I still have the melasma. It's looks like a mustache and I also have it on my forehead. I do not wear hairspray and change shampoos/conditioners pretty regularly.
Jenny

Zizzle · Post by **Zizzle** » Fri Aug 31, 2012 12:33 am

Hey sister,

I'm pretty convinced this is pigmented dermatitis, especially since it shares the same histology as my neck, shoulder, chest rash -- Vacuolar Interface Dermatitis. Apparently it can also affect the melanocytes, and of course, it's caused by...TA DA...lymphocyte infiltration of the skin!

Here's a good list of some of the allergens implicated:
http://emedicine.medscape.com/article/1 ... ical#a0218

Of course I'm already allergic to nickel, but I plan to check my hair products against this list.

I got my MRT results back - lots of surprise yellows but no reds. The nutritionist thinks if I eliminate yellows, my lymphocyte overactivity may calm down. We'll see. It's a tall order to eliminate bananas, apples avocado, onions, garlic and many others!

Separate post to follow...