Chloasma.

What do you understand by chloasma?

Chloasma consists of an abnormal deposit of pigment, occurring as variously-sized and shaped, yellowish, brownish or blackish patches.

Describe the clinical appearances of chloasma.

Chloasma appears either in ill-defined patches, as is commonly the case, or as a diffuse discoloration. Its appearance is rapid or gradual, generally the latter. The patches are rounded or irregular, and usually shade off into the sound skin. One, several or more may be present, and coalescence may take place, resulting in a large irregular pigmented area. The color is yellowish, or brownish, and may even be blackish (melasma, melanoderma). The skin is otherwise normal. The face is the most common site.

Into what two general classes may the various examples of chloasma be grouped?

Idiopathic and symptomatic.

What cases of chloasma are included in the idiopathic group?

All those cases of pigmentation caused by external agents, such as the sun's rays, sinapisms, blisters, continued cutaneous hyperæmia from scratching or any other cause, etc.

What cases of chloasma are included in the symptomatic group?

All forms of pigment deposit which occur as a consequence of various organic and systemic diseases, as the pigmentation, for instance, seen in association with tuberculosis, cancer, malaria, Addison's disease, uterine affections, and the like. In such cases, with few exceptions, the pigmentation is usually more or less diffuse.

What is chloasma uterinum?

Chloasma uterinum is a term applied to the ill-defined patches of yellowish-brown pigmentation appearing upon the faces of women, usually between the ages of twenty-five and fifty. It is most commonly seen during pregnancy, but may occur in connection with any functional or organic disease of the utero-ovarian apparatus.

What is argyria?

Argyria is the term applied to the slate-like discoloration which follows the prolonged administration of silver nitrate.

State the pathology of chloasma.

The sole change consists in an increased deposit of pigment.

Give the prognosis of chloasma.

Unless a removal of the exciting or predisposing cause is possible, the prognosis is, as a rule, unfavorable, and the relief furnished by local applications usually but temporary.

If constitutional treatment is advisable, upon what is it to be based?

Upon general principles; there are no special remedies.

How do external remedies act?

Mainly by removing the rete cells and with them the pigmentation; and partly, also, by stimulating the absorbents.

Are all external remedies which tend to remove the upper layers of the skin equally useful for this purpose?

No; on the contrary some such applications are followed by an increase in the pigment deposit.

Name the several applications commonly employed.

Corrosive sublimate in solution, in the strength of one to four grains to the ounce of alcohol and water; a lotion made up as follows:—

  ℞ Hydrargyri chlorid. corros., ..................... gr. iij-viij
   Ac. acet. dilut., ............................... fʒij
   Sodii borat., .................................... ℈ij
   Aquæ rosæ, ...................................... f℥iv.   M.

And also the following:—

  ℞ Hydrargyri chlorid. corros., ..................... gr. iij-viij
   Zinci sulphat.,
   Plumbi acetat., ..................āā.............. ʒss
   Aquæ, ........................................... f℥iv.   M.

And lactic acid, with from five to twenty parts of water; and an ointment containing a drachm each of bismuth subnitrate and white precipitate to the ounce. Hydrogen peroxide occasionally acts well. Trichloracetic acid, usually weakened with one or two parts water, may be cautiously tried. The application of a strong alcoholic solution of resorcin, twenty to fifty per cent. strength, is also valuable, as is also a two to ten per cent. alcoholic solution of salicylic acid.

(Applications are made two or three times daily, and as soon as slight scaliness or irritation is produced are to be discontinued for one or two days.)

Tattoo-marks are difficult to remove. Excision is the surest method. Electrolysis, applying the needle at various points, somewhat close together, and using a fairly strong current—three to eight milliampères—will exceptionally, especially when repeated several times, produce a reactive inflammation and casting-off of the tissue containing the pigment; a scar is left.

Several writers claim good results with glycerole of papain, pricking it in in the same manner as in tattooing.

Gun-powder marks. If recent, but a day or so after their occurrence, the larger specks may be picked or scraped out. Later, electrolysis, using a fairly strong current, may result in their removal. Their removal may also be satisfactorily effected with a minute cutaneous trephine.