Evaluation of Modified Melasma Area and Severity Index in Hyperthyroid Patients Receiving Anti-thyroid Drugs

Irma Bernadette S. Sitohang; Benny Nelson; Melani Marissa; Wresti  Indriatmi; Wismandari Wisnu

doi:10.3889/oamjms.2021.6082

Authors

Irma Bernadette S. Sitohang Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Benny Nelson Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Melani Marissa Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Wresti Indriatmi Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Wismandari Wisnu Department of Internal Medicine, Metabolic Endocrine Division, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.6082

Keywords:

Melasma, Modified melasma area and severity index, Hyperthyroid, Wood’s lamp

Abstract

BACKGROUND: Melasma is a common hyperpigmentation disorder, which causes brownish discoloration of the face. Despite unclear mechanisms, thyroid hormones were thought to play a role in melasma.

AIM: This study aims to determine and compare the clinical improvement of melasma in hyperthyroid patients receiving anti-thyroid drugs.

METHODS: An interventional study with a quasi-experimental design (pre-post-intervention study) was conducted at the Internal Medicine Outpatient Clinic and Dermatology and Venereology Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from July 2019 to March 2020. A comparative analysis was done to compare the modified melasma area and severity index (mMASI) in hyperthyroid patients before and after 12 weeks of anti-thyroid drugs. All subjects did not receive any additional topical therapies for their melasma. The clinical features were evaluated objectively at baseline and 12^th-week visit, by mMASI score on different areas of the face (forehead, left-right malar, and chin) and Wood’s lamp examination.

RESULTS: All areas showed a decline in mMASI score components (e.g., involvement areas and darkness degree) after 12 weeks of treatment. However, only the malar area showed a significant decline (p < 0.05). Wood’s lamp examination at baseline revealed dermal type melasma on 17 subjects, mixed type on six subjects, and epidermal type on one subject. All types remained unchanged after 12 weeks of treatment.

CONCLUSIONS: Our study demonstrated that mMASI score in malar area improved significantly, this might be because malar area included this study were comprised of epidermal, dermal, and mixed type. On the other hand, based on Wood’s lamp examination, all types of melasma remained unchanged after 12 weeks of treatment.

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References

Pollo CF, Meneguin S, Miot HA. Evaluation instruments for quality of life related to melasma: An integrative review. Clinics. 2018;73:65-6. https://doi.org/10.6061/clinics/2018/e65 DOI: https://doi.org/10.6061/clinics/2018/e65

Sarkar R, Arsiwala S, Dubey N, Sonthalia S, Das A, Arya L, et al. Chemical peels in melasma: A review with consensus recommendations by Indian pigmentary expert group. Indian J Dermatol. 2017;62(6):578-84. https://doi.org/10.4103/ijd. ijd_490_17 PMid:29263530 DOI: https://doi.org/10.4103/ijd.IJD_490_17

Nomakhosi M, Heidi A. Natural options for management of melasma, a review. J Cosmet Laser Ther. 2018;20(7-8):470-81. https://doi.org/10.1080/14764172.2018.1427874 PMid:29461133 DOI: https://doi.org/10.1080/14764172.2018.1427874

Pandya AG, Hynan LS, Bhore R, Riley FC, Guevara IL, Grimes P, et al. Reliability assessment and validation of the melasma area and severity index (MASI) and a new modified MASI scoring method. J Am Acad Dermatol. 2011;64(1):78-83. https://doi.org/10.1016/j.jaad.2009.10.051 PMid:20398960 DOI: https://doi.org/10.1016/j.jaad.2009.10.051

Asawanonda P, Taylor CR. Wood’s light in dermatology. Int J Dermatol. 1999;38(11):801-7. https://doi.org/10.1046/j.1365-4362.1999.00794.x PMid:10583611 DOI: https://doi.org/10.1046/j.1365-4362.1999.00794.x

McKesey J, Tovar-Garza A, Pandya AG. Melasma treatment: An evidence-based review. Am J Clin Dermatol. 2020;21(2):173- 225. https://doi.org/10.1007/s40257-019-00488-w PMid:31802394 DOI: https://doi.org/10.1007/s40257-019-00488-w

Pandya A, Berneburg M, Ortonne JP, Picardo M. Guidelines for clinical trials in melasma. Br J Dermatol. 2006;156(Suppl 1):21- 8. https://doi.org/10.1111/j.1365-2133.2006.07590.x PMid:17176301 DOI: https://doi.org/10.1111/j.1365-2133.2006.07590.x

Sheth VM, Pandya AG. Melasma: A comprehensive update. J Am Acad Dermatol. 2011;65(4):689-97. PMid:21920241 DOI: https://doi.org/10.1016/j.jaad.2010.12.046

Handel AC, Miot LD, Miot HA. Melasma: A clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-82. https://doi.org/10.1590/abd1806-4841.20143063 PMid:25184917 DOI: https://doi.org/10.1590/abd1806-4841.20143063

Jadotte YT, Schwartz RA. Melasma: Insights and perspectives. Acta Dermatovenerol Croat. 2010;18(2):124-9. PMid:20624364

Niepomniszcze H, Amad RH. Skin disorders and thyroid diseases. J Endocrinol Invest. 2001;24(8):628-38. https://doi.org/10.1007/bf03343905 PMid:11686547 DOI: https://doi.org/10.1007/BF03343905

Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzales EA, Villemur JA, et al. Associaton of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab. 1985;61(1):28-31. https://doi.org/10.1210/jcem-61-1-28 PMid:3923030 DOI: https://doi.org/10.1210/jcem-61-1-28

Ameneh Y, Banafsheh H. Association of melasma with thyroid autoimmunity: A case-control study. Iran J Dermatol. 2010;13(2):51-3.

Kiani AAM, Rezvaifar M. Asosiation between melasma and thyroid disorder. Iran J Dermatol. 2006;9:154-8.

Mogaddam MR, Alamdari MI, Maleki N, Ardabili NS, Abedkouhi S. Evaluation of autoimmune thyroid disease in melasma. J Cosmet Dermatol. 2015;14(2):167-71. https://doi.org/10.1111/jocd.12138 PMid:25810215 DOI: https://doi.org/10.1111/jocd.12138

Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M. Melasma and thyroid disorders: A systematic review and meta-analysis. Int J Dermatol. 2019;58(11):1231-8. https://doi.org/10.1111/ijd.14497 PMid:31149743 DOI: https://doi.org/10.1111/ijd.14497

Perez M, Hez JL, Aguilo F. Endocrinologic profile of patients with idiopathic melasma. J Invest Dermatol. 1983;81(6):543-5. PMid:6644096 DOI: https://doi.org/10.1111/1523-1747.ep12522896

Bak H, Lee HJ, Chang SE, Choi JH, Kim MN, Kim BJ. Increased expression of nerve growth factor receptor and neural endopeptidase in the lesional skin of melasma. Dermatol Surg. 2009;35(8):1244-50. https://doi.org/10.1111/j.1524-4725.2009.01219.x PMid:19438666 DOI: https://doi.org/10.1111/j.1524-4725.2009.01219.x

Sarkar R, Arora P, Garg VK, Sonthalia S, Gokhale N. Melasma update. Indian Dermatol Online J. 2014;5(4):426-35. https://doi.org/10.4103/2229-5178.142484 PMid:25396123 DOI: https://doi.org/10.4103/2229-5178.142484

Sarkar R, Gokhale N, Godse K, Ailawadi P, Arya L, Sarma N, et al. Medical management of melasma: A review with consensus recommendations by Indian pigmentary expert group. Indian J Dermatol. 2017;62(6):450-69. https://doi.org/10.4103/ijd.ijd_489_17 PMid:29263529 DOI: https://doi.org/10.4103/ijd.IJD_489_17

Lima EVA, Lima M, Paixão MP, Miot HA. Assessment of the effects of skin microneedling as adjuvant therapy for facial melasma: A pilot study. BMC Dermatol. 2017;17(1):14. https://doi.org/10.1186/s12895-017-0066-5 PMid:29183309 DOI: https://doi.org/10.1186/s12895-017-0066-5

Goh J, Dlova C. A retrospective study on the clinical presentation and treatment outcome of melasma in a tertiary dermatological referral centre in Singapore. Singapore Med J. 1999;40(7):455-8. PMid:10560271

Guarneri F. Etiopathogenesis of melasma. J Pigment Disord. 2014;S1(3):1-5.

Achar A, Rathi SK. Melasma: A clinico-epidemiological study of 312 cases. Indian J Dermatol. 2011;56(4):380-2. https://doi.org/10.4103/0019-5154.84722 PMid:21965843 DOI: https://doi.org/10.4103/0019-5154.84722

Bagherani N, Gianfaldoni S, Smoller B. An overview on melasma. J Pigment Disord 2015;2:218.

Tamega A, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venereol. 2013;27(2):151-6. https://doi.org/10.1111/j.1468-3083.2011.04430.x PMid:22212073 DOI: https://doi.org/10.1111/j.1468-3083.2011.04430.x

Kwon SH, Hwang YJ, Lee SK, Park KC. Heterogeneous pathology of melasma and its clinical implications. Int J Mol Sci. 2016;17(6):824-34. PMid:27240341 DOI: https://doi.org/10.3390/ijms17060824

Lee A. An updated review of melasma pathogenesis. Dermatol Sin. 2014;32:233-9. DOI: https://doi.org/10.1016/j.dsi.2014.09.006

Anagnostis P, Adamidou F, Polyzos SA, Katergari S, Karathanasi E, Zouli C, et al. Predictors of long-term remission in patients with Graves’ disease: A single center experience. Endocrine. 2013;44(2):448-53. https://doi.org/10.1007/s12020-013-9895-0 PMid:23397523 DOI: https://doi.org/10.1007/s12020-013-9895-0

Kravets I. Hyperthyroidism: Diagnosis and treatment. Am Fam Physician. 2016;93(5):363-70. PMid:26926973

Rodrigues M, Ayala-Cortés AS, Rodríguez-Arámbula A, Hynan LS, Pandya AG. Interpretability of the modified melasma area and severity index (mMASI). JAMA Dermatol. 2016;152(9):1051-2. https://doi.org/10.1001/jamadermatol.2016.1006 PMid:27144383 DOI: https://doi.org/10.1001/jamadermatol.2016.1006

Rozing MP, Westendorp RG, Maier AB, Wijsman CA, Frölich M, de Craen AJ, et al. Serum triiodothyronine levels and inflammatory cytokine production capacity. Am Aging Assoc. 2012;34(1):195- 201. https://doi.org/10.1007/s11357-011-9220-x PMid:21350816 DOI: https://doi.org/10.1007/s11357-011-9220-x